MEDICARE: BALANCED ROCK CHIROPRACTIC INC

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		CO

General Provider Information

NPI Number	:	1407024599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCED ROCK CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	5525 N UNION BLVD
Second Line	:	SUITE 101
City	:	COLORADO SPGS
State	:	CO
Zip	:	80918-1969
Country	:	US
Telephone Number	:	719-260-5525
Fax Number	:

Provider Business Practice Location Address
First Line	:	5525 N UNION BLVD
Second Line	:	SUITE 101
City	:	COLORADO SPGS
State	:	CO
Zip	:	80918-1969
Country	:	US
Telephone Number	:	719-260-5525
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LYNN S CASH
Credential	:	DC
Telephone Number	:	719-260-5525

Provider Enumeration Date	:	02/12/2008
Last Update Date	:	04/18/2012

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