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General NPI Number Information
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NPI Number | 1255880712
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Entity Type | Organization
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Legal Business Name | IN BALANCE ACU CORP
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Dates
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Enumeration Date | 09/26/2016
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Last Update Date | 09/26/2016
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Provider Practice Location Address
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Address Line | 65 AIR PARK DR
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City | RONKONKOMA
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State | NY
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Zip | 11779-7374
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Country | US
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Telephone | 631-559-5934
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Fax |
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Provider Business Mailing Address
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Address Line | 48 JOHNSON AVE N
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City | KINGS PARK
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State | NY
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Zip | 11754-3519
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Country | US
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Telephone | 631-559-5934
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | RALPH EDWARD HINKSON
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Credential | LAC
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Telephone | 631-559-5934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 04778
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License Number State | NY
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