Provider Demographics
NPI:1164249710
Name:BALANCED RIVER CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BALANCED RIVER CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:INDYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-671-9177
Mailing Address - Street 1:2055 BARRETT LAKES BLVD NW APT 1014
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-8004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:425 BARRETT PKWY
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-4990
Practice Address - Country:US
Practice Address - Phone:678-383-9994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty