Provider Demographics
NPI:1104487602
Name:OPTIMAL BALANCE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:OPTIMAL BALANCE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRIETT MAE
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-873-9841
Mailing Address - Street 1:7363 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1230
Mailing Address - Country:US
Mailing Address - Phone:708-209-1155
Mailing Address - Fax:708-209-1926
Practice Address - Street 1:7363 NORTH AVE
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1230
Practice Address - Country:US
Practice Address - Phone:708-209-1155
Practice Address - Fax:708-209-1926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty