MEDICARE: BACK IN BALANCE FAMILY CHIROPRACTIC

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	:	1619451077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK IN BALANCE FAMILY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	2311 WAKARUSA DR STE C
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66047-3350
Country	:	US
Telephone Number	:	785-424-7384
Fax Number	:

Provider Business Practice Location Address
First Line	:	2311 WAKARUSA DR STE C
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66047-3350
Country	:	US
Telephone Number	:	785-424-7384
Fax Number	:	833-300-9392

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHANIE MILLER
Credential	:	DC
Telephone Number	:	573-694-5162

Provider Enumeration Date	:	09/21/2018
Last Update Date	:	10/17/2018

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