1609414572 NPI number — INNER BALANCE MEDICINE, ACUPUNCTURE CORP

Table of content: (NPI 1609414572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609414572 NPI number — INNER BALANCE MEDICINE, ACUPUNCTURE CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNER BALANCE MEDICINE, ACUPUNCTURE CORP
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:
1609414572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 S HAM LN STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LODI
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95242-7502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-369-5008
Provider Business Mailing Address Fax Number:
209-713-4680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1121 W VINE ST STE 15
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LODI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95240-5137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-369-5008
Provider Business Practice Location Address Fax Number:
209-713-4680
Provider Enumeration Date:
12/11/2019

Additional Information

Authorized Official

Authorized Official Last Name:
SCHWARTZ
Authorized Official First Name:
CONNIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
209-570-0486

Provider Taxonomy Codes

  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: C4263823 . This is a "ARTICLES OF INCORPORATION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com