Organization Active NPI

Life in Balance Wellness LLC

  • Chiropractor
  • Travelers Rest, SC
National Provider Identifier
1902569536
Registry record updated Oct 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
LIFE IN BALANCE WELLNESS LLC
Practice address
101 Center St
Travelers Rest, SC 29690-1828
Phone
(979) 995-4909
NPI assigned
Oct 20, 2021
Last updated
Oct 20, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2021

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

Authorized official

Name
Dr. Chris Alan Kowalik, DCNPI 1235260712
Title
Owner
Phone
(979) 995-4909

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X Primary

Addresses

Primary practice location

101 Center St
Travelers Rest, SC 29690-1828

Mailing address

215 Love Dr
Travelers Rest, SC 29690-1806

Other identifiers 1

IdentifierTypeStateIssuer
4469OtherSCMEDICAL LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Janeapp Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211221001028 SC Part B Supplier - Clinic/Group Practice 8921499211 Receives reassigned benefits from 1 practitioner
Practice locations: Travelers Rest, SC

National Provider Directory

National Provider Directory

Locations

101 Center St
Travelers Rest, SC 29690
Phone (978) 995-4909

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1634688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634688000000",
    "number": "1902569536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 LOVE DR",
            "city": "TRAVELERS REST",
            "state": "SC",
            "postal_code": "296901806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 CENTER ST",
            "city": "TRAVELERS REST",
            "state": "SC",
            "postal_code": "296901828",
            "telephone_number": "979-995-4909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE IN BALANCE WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-20",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A",
        "authorized_official_last_name": "KOWALIK",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "979-995-4909",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "4469",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Janeapp",
            "affiliation": "N",
            "endpointDescription": "Software",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Software",
            "address_1": "101 Center St",
            "city": "Travelers Rest",
            "state": "SC",
            "country_code": "US",
            "postal_code": "296901828",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Travelers Rest, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2021; 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.