Healthcare Provider Details

I. General information

NPI: 1679317861
Provider Name (Legal Business Name): A NATURAL BALANCE HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 BROADWAY ST
VANCOUVER WA
98663-3229
US

IV. Provider business mailing address

17800 NE 37TH ST
VANCOUVER WA
98682-3734
US

V. Phone/Fax

Practice location:
  • Phone: 360-241-6630
  • Fax: 360-843-1629
Mailing address:
  • Phone: 503-997-1635
  • Fax: 360-843-1629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: DR. TANIS KLECKLER
Title or Position: OWNER, CEO, PHYSICIAN
Credential: ND LAC
Phone: 503-997-1635