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General NPI Number Information
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NPI Number | 1669994695
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Entity Type | Organization
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Legal Business Name | INNER BALANCE ACUPUNCTURE
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Dates
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Enumeration Date | 07/11/2017
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Last Update Date | 07/11/2017
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Provider Practice Location Address
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Address Line | 22762 ASPAN ST STE 201
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City | LAKE FOREST
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State | CA
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Zip | 92630-1604
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Country | US
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Telephone | 949-235-9494
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Fax |
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Provider Business Mailing Address
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Address Line | 23785 EL TORO RD # 111
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City | LAKE FOREST
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State | CA
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Zip | 92630-4762
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Country | US
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Telephone | 949-235-9494
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRET JAMES ELLINGTON
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Credential | DACM, LAC
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Telephone | 949-235-9494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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