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General NPI Number Information
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NPI Number | 1609414572
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Entity Type | Organization
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Legal Business Name | INNER BALANCE MEDICINE, ACUPUNCTURE CORP
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Dates
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Enumeration Date | 12/11/2019
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Last Update Date | 12/11/2019
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Provider Practice Location Address
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Address Line | 1121 W VINE ST STE 15
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City | LODI
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State | CA
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Zip | 95240-5137
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Country | US
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Telephone | 209-369-5008
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Fax | 209-713-4680
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Provider Business Mailing Address
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Address Line | 801 S HAM LN STE B
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City | LODI
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State | CA
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Zip | 95242-7502
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Country | US
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Telephone | 209-369-5008
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Fax | 209-713-4680
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Authorized Official
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Title or Position | OWNER
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Name | CONNIE SCHWARTZ
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Credential | L.AC.
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Telephone | 209-570-0486
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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 |
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License Number State |
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