Provider Demographics
NPI:1538252929
Name:BACK IN BALANCE, PA
Entity type:Organization
Organization Name:BACK IN BALANCE, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:828-274-9799
Mailing Address - Street 1:1089 HENDERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1801
Mailing Address - Country:US
Mailing Address - Phone:828-274-9799
Mailing Address - Fax:828-274-9799
Practice Address - Street 1:1089 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1801
Practice Address - Country:US
Practice Address - Phone:828-274-9799
Practice Address - Fax:828-274-9799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2941111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085FXOtherBCBS
NC89085FXMedicaid
NC0194LOtherCNC
NC89085FXMedicaid
NC0194LOtherCNC