Provider Demographics
NPI:1942336987
Name:BALANCED HEALTH CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:BALANCED HEALTH CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DOMBROSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-772-9255
Mailing Address - Street 1:300 S STATE ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-1676
Mailing Address - Country:US
Mailing Address - Phone:616-772-9255
Mailing Address - Fax:616-772-9258
Practice Address - Street 1:52B EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1770
Practice Address - Country:US
Practice Address - Phone:616-772-9255
Practice Address - Fax:616-772-9258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISD008737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU98076Medicare UPIN
MI0N83030Medicare ID - Type Unspecified