Provider Demographics
NPI:1851837710
Name:BALANCE RESTORED CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:BALANCE RESTORED CHIROPRACTIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:PETRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-809-4594
Mailing Address - Street 1:3788 55TH AVE S STE 105
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7331
Mailing Address - Country:US
Mailing Address - Phone:701-809-4594
Mailing Address - Fax:701-291-8778
Practice Address - Street 1:3788 55TH AVE S STE 105
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7331
Practice Address - Country:US
Practice Address - Phone:701-809-4594
Practice Address - Fax:701-291-8778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-16
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty