Provider Demographics
NPI:1730211004
Name:BALANCE AND SUPPORT DYNAMICS, LLC
Entity type:Organization
Organization Name:BALANCE AND SUPPORT DYNAMICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:865-273-2013
Mailing Address - Street 1:1431 E HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-3261
Mailing Address - Country:US
Mailing Address - Phone:865-984-5588
Mailing Address - Fax:865-238-0211
Practice Address - Street 1:1431 E HARPER AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-3261
Practice Address - Country:US
Practice Address - Phone:865-984-5588
Practice Address - Fax:865-238-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2427332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5645510001Medicare NSC