=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316317183
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTH BALANCE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2015
-----------------------------------------------------
Last Update Date | 10/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3406 DAVENPORT AVE STE A
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48602-3374
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-799-9900
-----------------------------------------------------
Fax | 989-799-9862
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3406 DAVENPORT AVE STE A
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48602-3374
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-799-9900
-----------------------------------------------------
Fax | 989-799-9862
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACUPUNCTURIST
-----------------------------------------------------
Name | YA CHU
-----------------------------------------------------
Credential | LAC
-----------------------------------------------------
Telephone | 989-992-8564
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number | 7501000660
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number | 5401000079
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------