Provider Demographics
NPI:1588667745
Name:BALANCED LIVING CHIROPRACTIC CLINIC, INC
Entity type:Organization
Organization Name:BALANCED LIVING CHIROPRACTIC CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BITSKAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-725-5277
Mailing Address - Street 1:708 E SMITH RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2662
Mailing Address - Country:US
Mailing Address - Phone:330-725-5277
Mailing Address - Fax:330-725-4241
Practice Address - Street 1:708 E SMITH RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2662
Practice Address - Country:US
Practice Address - Phone:330-725-5277
Practice Address - Fax:330-725-4241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1734111N00000X
OH1685111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0221638Medicaid
OH34178207500OtherBWC- DR. MARK
OH131566870-005OtherMEDICAL MUTUAL-DR. MARK
OH34177451400OtherBWC-DR. JEANINE
OH000000139760OtherANTHEM-DR.MARK
OH000000139761OtherANTHEM-DR.JEANINE
OH0826020Medicaid
OH0857210Medicaid
OH200505615-006OtherMEDICAL MUTUAL-DR.JEANINE
OH000000139761OtherANTHEM-DR.JEANINE
OH34177451400OtherBWC-DR. JEANINE
OH0857210Medicaid
OHBI0693204Medicare ID - Type UnspecifiedDR. MARK
OH0221638Medicaid
OH34177451400OtherBWC-DR. JEANINE
OHBA9283421Medicare ID - Type UnspecifiedGROUP