Provider Demographics
NPI:1104308311
Name:BALANCED LIVING CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:BALANCED LIVING CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:PERIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-597-4784
Mailing Address - Street 1:6405 NE 116TH AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-2402
Mailing Address - Country:US
Mailing Address - Phone:360-597-4784
Mailing Address - Fax:
Practice Address - Street 1:6405 NE 116TH AVE STE 106
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-2402
Practice Address - Country:US
Practice Address - Phone:360-597-4784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60153876111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty