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General NPI Number Information
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NPI Number | 1558654004
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Entity Type | Organization
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Legal Business Name | BALANCED HEALTH ACUPUNCTURE, PC
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Dates
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Enumeration Date | 05/17/2011
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Last Update Date | 05/17/2011
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Provider Practice Location Address
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Address Line | 3001 MAIN STREET
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City | VALATIE
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State | NY
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Zip | 12184
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Country | US
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Telephone | 518-758-7711
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Fax | 646-810-3957
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Provider Business Mailing Address
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Address Line | 12 JAMES LN
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City | KINDERHOOK
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State | NY
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Zip | 12106-2313
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Country | US
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Telephone | 917-373-2466
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Fax | 646-810-3957
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Authorized Official
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Title or Position | OWNER
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Name | MS. EVELYN CHAN
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Credential | LAC
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Telephone | 917-373-2466
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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 | 003118
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License Number State | NY
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