MEDICARE: BALANCED APPROACH FAMILY WELLNESS, PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	7810	AZ

General Provider Information

NPI Number	:	1093909947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCED APPROACH FAMILY WELLNESS, PLC

Provider Business Mailing Address
First Line	:	18517 W PORT AU PRINCE LN
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85388-7577
Country	:	US
Telephone Number	:	928-536-5525
Fax Number	:	928-536-3010

Provider Business Practice Location Address
First Line	:	18517 W PORT AU PRINCE LN
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85388-7577
Country	:	US
Telephone Number	:	928-536-5525
Fax Number	:	928-536-3010

Authorized Official
Title or Position	:	OWNER/MEMBER
Name	:	DR. JASON LEE MULDER
Credential	:	D.C.
Telephone Number	:	928-536-5525

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	09/04/2007

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