Healthcare Provider Details

I. General information

NPI: 1972887701
Provider Name (Legal Business Name): BODY BALANCE ACUPUNCTURE & HERB CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 DTC PKWY STE 400
GREENWOOD VILLAGE CO
80111-3095
US

IV. Provider business mailing address

5300 DTC PKWY STE 400
GREENWOOD VILLAGE CO
80111-3095
US

V. Phone/Fax

Practice location:
  • Phone: 303-929-3331
  • Fax: 720-282-0132
Mailing address:
  • Phone: 303-929-3331
  • Fax: 720-282-0132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1232
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7086
License Number StateCO

VIII. Authorized Official

Name: SEOUNG R JEE
Title or Position: OWNER
Credential: OMD, LAC
Phone: 303-929-3331