MEDICARE: BALANCED BODY 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	111N00000X	Chiropractor	038012304	IL

General Provider Information

NPI Number	:	1790179976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCED BODY CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	1231 FARMINGTON LAKES DR
Second Line	:	SUITE 101
City	:	OSWEGO
State	:	IL
Zip	:	60543-5109
Country	:	US
Telephone Number	:	331-212-6962
Fax Number	:	630-429-9276

Provider Business Practice Location Address
First Line	:	1231 FARMINGTON LAKES DR
Second Line	:	SUITE 101
City	:	OSWEGO
State	:	IL
Zip	:	60543-5109
Country	:	US
Telephone Number	:	331-212-6962
Fax Number	:	630-429-9276

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KRISTEN ACCARDO
Credential	:	D.C.
Telephone Number	:	331-212-6962

Provider Enumeration Date	:	03/25/2015
Last Update Date	:	03/25/2015

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