Provider Demographics
NPI:1861721144
Name:BALANCED BODY HEALTHCARE
Entity type:Organization
Organization Name:BALANCED BODY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-464-7260
Mailing Address - Street 1:104 OVERLEAF PT SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35824-3102
Mailing Address - Country:US
Mailing Address - Phone:256-464-7260
Mailing Address - Fax:256-772-7066
Practice Address - Street 1:8121 MADISON BLVD STE 102
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2018
Practice Address - Country:US
Practice Address - Phone:256-464-7260
Practice Address - Fax:256-772-7066
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRANAE HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QC1500X, 261QV0200X
AL2286261QH0100X, 261QR0200X, 111N00000X
AL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA