MEDICARE: THE BODY BALANCING CENTER PC

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

General Provider Information

NPI Number	:	1184664500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE BODY BALANCING CENTER PC

Provider Business Mailing Address
First Line	:	1410 INCARNATION DR
Second Line	:	SUITE 204
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-5708
Country	:	US
Telephone Number	:	434-817-7788
Fax Number	:

Provider Business Practice Location Address
First Line	:	1410 INCARNATION DR
Second Line	:	SUITE 204
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-5708
Country	:	US
Telephone Number	:	434-817-7788
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. MICHAEL J RUSSAMANO
Credential	:	D.C.
Telephone Number	:	434-817-7788

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	08/22/2020

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