Healthcare Provider Details

I. General information

NPI: 1093909947
Provider Name (Legal Business Name): BALANCED APPROACH FAMILY WELLNESS, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18517 W PORT AU PRINCE LN
SURPRISE AZ
85388-7577
US

IV. Provider business mailing address

18517 W PORT AU PRINCE LN
SURPRISE AZ
85388-7577
US

V. Phone/Fax

Practice location:
  • Phone: 928-536-5525
  • Fax: 928-536-3010
Mailing address:
  • Phone: 928-536-5525
  • Fax: 928-536-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7810
License Number StateAZ

VIII. Authorized Official

Name: DR. JASON LEE MULDER
Title or Position: OWNER/MEMBER
Credential: D.C.
Phone: 928-536-5525