1609053057 NPI number — LIVING IN BALANCE HEALTH CENTER, P.A.

Table of content: (NPI 1609053057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609053057 NPI number — LIVING IN BALANCE HEALTH CENTER, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIVING IN BALANCE HEALTH CENTER, P.A.
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:
1609053057
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1139
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAYMOND
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03077-1139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-895-1658
Provider Business Mailing Address Fax Number:
603-895-9394

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
74 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAYMOND
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-895-1658
Provider Business Practice Location Address Fax Number:
603-895-9394
Provider Enumeration Date:
01/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RAJCHEL
Authorized Official First Name:
JAN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
603-896-1658

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  026553-23-03 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: 033294-21 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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