Healthcare Provider Details

I. General information

NPI: 1386299675
Provider Name (Legal Business Name): BALANCE & WELLBEING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 PERIMETER DR STE 1100
SCHAUMBURG IL
60173-5079
US

IV. Provider business mailing address

PO BOX 699
CAMAS WA
98607-0699
US

V. Phone/Fax

Practice location:
  • Phone: 630-344-9617
  • Fax: 847-648-4122
Mailing address:
  • Phone: 360-903-1829
  • Fax: 360-991-0337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOVEL BROQUEZA
Title or Position: ADMINISTRATOR
Credential: APRN
Phone: 630-344-9617