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General NPI Number Information
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NPI Number | 1730451493
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Entity Type | Organization
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Legal Business Name | IDEAL BALANCE, INC.
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Dates
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Enumeration Date | 01/27/2012
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Last Update Date | 02/28/2012
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Provider Practice Location Address
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Address Line | 10927 N 56TH ST
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City | TEMPLE TERRACE
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State | FL
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Zip | 33617-3000
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Country | US
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Telephone | 813-766-1319
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Fax | 888-440-0629
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Provider Business Mailing Address
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Address Line | 9613 N 55TH ST
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City | TEMPLE TERRACE
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State | FL
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Zip | 33617-4723
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Country | US
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Telephone | 813-766-1319
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Fax | 888-440-0629
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. BRIAN SCOTT LAU
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Credential | AP DOM LMT
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Telephone | 813-766-1319
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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 | 3036
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License Number State | FL
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