Provider Demographics
NPI:1427115773
Name:BALANCE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BALANCE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLOWS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-985-0720
Mailing Address - Street 1:6750 E MAIN ST STE 108
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-9049
Mailing Address - Country:US
Mailing Address - Phone:480-985-0720
Mailing Address - Fax:
Practice Address - Street 1:6750 E MAIN ST STE 108
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-9049
Practice Address - Country:US
Practice Address - Phone:480-985-0720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7764111N00000X
AZ4447111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ112757Medicare PIN