Provider Demographics
NPI:1538603238
Name:INTELLIGENT BALANCE CHIROPRACTIC SPINAL CARE, PLLC
Entity type:Organization
Organization Name:INTELLIGENT BALANCE CHIROPRACTIC SPINAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-924-4443
Mailing Address - Street 1:2310 N MOLTER RD
Mailing Address - Street 2:STE 108
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-5036
Mailing Address - Country:US
Mailing Address - Phone:509-924-4443
Mailing Address - Fax:509-924-1249
Practice Address - Street 1:56 N CLARK AVE
Practice Address - Street 2:UNIT 1
Practice Address - City:REPUBLIC
Practice Address - State:WA
Practice Address - Zip Code:99166-5024
Practice Address - Country:US
Practice Address - Phone:509-775-2553
Practice Address - Fax:509-924-1249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty