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General NPI Number Information
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NPI Number | 1215365358
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Entity Type | Organization
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Legal Business Name | NATURAL BALANCE PAIN AND WELLNESS CENTER INC.
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 1258 ORTIZ DR SE 301-303
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-4635
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Country | US
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Telephone | 815-603-9755
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Fax |
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Provider Business Mailing Address
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Address Line | 6409 SUNNY DAY CT NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-6144
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Country | US
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Telephone | 815-603-9755
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. RANDY LEE JR.
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Credential | DN
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Telephone | 815-603-9755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD2007-0654
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 172P00000X
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Taxonomy Name | Naprapath
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License Number | 0021
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License Number State | NM
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