Dynamic Balance Wellness, L.L.C

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

01590 Issued in CT

Legal business name

DYNAMIC BALANCE WELLNESS, L.L.C

Practice address

150 Hazard Ave Ste C7
Enfield, CT 06082-4587

Phone

(860) 749-4148

Fax

(860) 749-4241

NPI assigned

Aug 24, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Craig Kelly, LA.C.

Title

Owner

Phone

(860) 749-4148

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ya-Ling Lo

  • Chiropractor
  • Enfield, CT
  • NPI 1265606511
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1251072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251072000000",
    "number": "1881827947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 HAZARD AVE STE C7",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "060824587",
            "telephone_number": "860-749-4148",
            "fax_number": "860-749-4241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 HAZARD AVE STE C7",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "060824587",
            "telephone_number": "860-749-4148",
            "fax_number": "860-749-4241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC BALANCE WELLNESS, L.L.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-24",
        "last_updated": "2009-08-24",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-749-4148",
        "authorized_official_credential": "LA.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "CT",
            "license": "01590",
            "primary": true
        },
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": "CT",
            "license": "000329",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paula Dunn
• Dushyant Parikh
• Theresa Duston
• Cheryl Dusza, MSW
• Gideon Dwomo
• E Steven Damon, D.P.M.
• E. Steven Damon, D.P.M.
• Eastern Rehabilitation Network
• Pearl-Ruth Eben
• Echn Johnson Health Care, Inc.

• Chiropractor in Enfield, CT
• Providers in Enfield, CT by specialty
• Chiropractor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.