NPI Code Detail JSON Logo

1104700178 NPI number — BLOOM AND BALANCE PLLC

NPI Number: 1104700178
Health Care Provider/Practitioner: BLOOM AND BALANCE PLLC

Information about “1104700178” NPI (BLOOM AND BALANCE PLLC) exists in 1104700178 in HTML format HTML  |  1104700178 in plain Text format TXT  |  1104700178 in PDF (Portable Document Format) PDF  |  1104700178 in an XML format XML  formats.

NPI Number : 1104700178 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104700178",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "BLOOM AND BALANCE PLLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "330 W LAKE LANSING RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EAST LANSING",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48823-8527",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "517-858-2865",
    "MailingAddressFaxNumber": "517-225-0490",
    "FirstLinePracticeLocationAddress": "330 W LAKE LANSING RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "EAST LANSING",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48823-8527",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "517-858-2865",
    "PracticeLocationAddressFaxNumber": "517-225-0490",
    "EnumerationDate": "08/04/2025",
    "LastUpdateDate": "08/04/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "STENLUND",
    "AuthorizedOfficialFirstName": "KATHLEEN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "517-858-2865",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "204D00000X",
        "TaxonomyName": "Neuromusculoskeletal Medicine & OMM Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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