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General NPI Number Information
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NPI Number | 1952115438
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Entity Type | Organization
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Legal Business Name | BACK IN BALANCE
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 3720 WILBARGER ST
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City | VERNON
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State | TX
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Zip | 76384-3259
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Country | US
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Telephone | 940-357-9447
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Fax | 940-552-2382
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Provider Business Mailing Address
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Address Line | 3720 WILBARGER ST
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City | VERNON
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State | TX
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Zip | 76384-3259
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Country | US
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Telephone | 940-357-9447
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Fax | 940-552-2382
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Authorized Official
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Title or Position | OWNER
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Name | DR. JESSICA NICOLE BODILY
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Credential | DC
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Telephone | 817-980-0551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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