Provider Demographics
NPI:1407024599
Name:BALANCED ROCK CHIROPRACTIC INC
Entity type:Organization
Organization Name:BALANCED ROCK CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CASH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-260-5525
Mailing Address - Street 1:5525 N UNION BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLORADO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1969
Mailing Address - Country:US
Mailing Address - Phone:719-260-5525
Mailing Address - Fax:
Practice Address - Street 1:5525 N UNION BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:COLORADO SPGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1969
Practice Address - Country:US
Practice Address - Phone:719-260-5525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C489308Medicare PIN