MEDICARE: BALANCED HEALTH AND BODY,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	261QH0100X	Health Service Clinic/Center	CH3035	MA

General Provider Information

NPI Number	:	1841528015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCED HEALTH AND BODY,LLC

Provider Business Mailing Address
First Line	:	26 BRIGHTON ST STE 300
Second Line	:
City	:	BELMONT
State	:	MA
Zip	:	02478-4043
Country	:	US
Telephone Number	:	617-993-9936
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 MAPLE ST
Second Line	:
City	:	MALDEN
State	:	MA
Zip	:	02148-3818
Country	:	US
Telephone Number	:	781-322-3091
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DANIEL J KELLY
Credential	:	D.C.
Telephone Number	:	617-993-9936

Provider Enumeration Date	:	11/30/2009
Last Update Date	:	11/30/2009

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