1871865188 NPI number — BODY BALANCED CARE, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871865188 NPI number — BODY BALANCED CARE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BODY BALANCED CARE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871865188
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3315 W MAYFLOWER WAY STE 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEHI
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84043-2927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-224-3031
Provider Business Mailing Address Fax Number:
801-890-3924

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3315 W MAYFLOWER WAY STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEHI
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84043-2927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-224-3031
Provider Business Practice Location Address Fax Number:
801-890-3924
Provider Enumeration Date:
02/01/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DELGADO
Authorized Official First Name:
JUAN
Authorized Official Middle Name:
JOSE
Authorized Official Title or Position:
MANAGING OWNER
Authorized Official Telephone Number:
801-224-3031

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  3085392-4405 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)