Organization
BALANCE CHIROPRACTIC CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HUTAN GHOJALLU DC (OWNER)
(262) 240-0136
Entity
Organization
Contact information
Practice address
10033 N PORT WASHINGTON RD, SUITE 100, MEQUON, WI 53092-5799
(262) 240-0136
(262) 240-0139
Mailing address
10033 N PORT WASHINGTON RD, SUITE 100, MEQUON, WI 53092-5799
(262) 240-0136
(262) 240-0139
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3228
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38893100
—
WI
Enumeration date
09/26/2006
Last updated
01/16/2008
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