MEDICARE: BALANCE HEALTH STUDIO

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	CH8927	FL

General Provider Information

NPI Number	:	1679725683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCE HEALTH STUDIO

Provider Business Mailing Address
First Line	:	3547 E COUNTY HIGHWAY 30A
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-7433
Country	:	US
Telephone Number	:	850-231-9288
Fax Number	:	678-225-4701

Provider Business Practice Location Address
First Line	:	3547 E COUNTY HIGHWAY 30A
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-7433
Country	:	US
Telephone Number	:	850-231-9288
Fax Number	:	678-225-4701

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	COLLEEN LAFITA
Credential	:
Telephone Number	:	678-225-4701

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	10/21/2008

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Directions to “BALANCE HEALTH STUDIO ” Practice Location

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