Provider Demographics
NPI:1174778880
Name:BACK INTO BALANCE
Entity type:Organization
Organization Name:BACK INTO BALANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:ND, DC
Authorized Official - Phone:425-827-0334
Mailing Address - Street 1:433 STATE STREET SOUTH
Mailing Address - Street 2:SUITE 6
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6615
Mailing Address - Country:US
Mailing Address - Phone:425-827-0334
Mailing Address - Fax:425-284-6884
Practice Address - Street 1:433 STATE STREET SOUTH
Practice Address - Street 2:SUITE 6
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6615
Practice Address - Country:US
Practice Address - Phone:425-827-0334
Practice Address - Fax:425-284-6884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty