Healthcare Provider Details

I. General information

NPI: 1568947232
Provider Name (Legal Business Name): INNER BALANCE ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 SOUTHLAND DR STE 101
LEXINGTON KY
40503-1946
US

IV. Provider business mailing address

274 SOUTHLAND DR STE 101
LEXINGTON KY
40503-1946
US

V. Phone/Fax

Practice location:
  • Phone: 859-595-2164
  • Fax:
Mailing address:
  • Phone: 859-595-2164
  • Fax: 855-237-3143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT FUESTON
Title or Position: OWNER
Credential:
Phone: 859-595-2164