MEDICARE: BALANCE CHIROPRACTIC, LLC

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	111NS0005X	Sports Physician Chiropractor
2	111NS0005X	Sports Physician Chiropractor	006.0091379	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326421686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCE CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	4066 SHELBURNE RD
Second Line	:	SUITE 8
City	:	SHELBURNE
State	:	VT
Zip	:	05482-6905
Country	:	US
Telephone Number	:	802-985-5833
Fax Number	:	802-985-2385

Provider Business Practice Location Address
First Line	:	4066 SHELBURNE RD
Second Line	:	SUITE 8
City	:	SHELBURNE
State	:	VT
Zip	:	05482-6905
Country	:	US
Telephone Number	:	802-985-5833
Fax Number	:	802-985-2385

Authorized Official
Title or Position	:	OWNER
Name	:	MILES COLAPRETE
Credential	:	DC
Telephone Number	:	802-985-5833

Provider Enumeration Date	:	07/06/2015
Last Update Date	:	08/02/2022

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