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General NPI Number Information
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NPI Number | 1083036081
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Entity Type | Organization
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Legal Business Name | BALANCED HEALTHCARE
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Dates
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Enumeration Date | 01/09/2014
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Last Update Date | 01/21/2014
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Provider Practice Location Address
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Address Line | 4691 S UNIVERSITY DR
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City | DAVIE
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State | FL
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Zip | 33328-3817
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Country | US
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Telephone | 954-729-2530
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Fax |
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Provider Business Mailing Address
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Address Line | 4691 S UNIVERSITY DR
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City | DAVIE
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State | FL
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Zip | 33328-3817
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIE QIAB
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Credential |
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Telephone | 786-200-9257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | ME83875
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License Number State | FL
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