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General NPI Number Information
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NPI Number | 1972950871
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Entity Type | Organization
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Legal Business Name | BALANCED NATURAL HEALTH AND WELLNESS, LLC
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Dates
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Enumeration Date | 05/20/2016
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Last Update Date | 05/20/2016
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Provider Practice Location Address
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Address Line | 952 BETHANY TPKE
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City | HONESDALE
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State | PA
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Zip | 18431-4194
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Country | US
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Telephone | 570-445-1122
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Fax |
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Provider Business Mailing Address
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Address Line | 952 BETHANY TPKE
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City | HONESDALE
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State | PA
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Zip | 18431-4194
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ORGANIZER
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Name | MICHELLE HEAD
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Credential | DC
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Telephone | 570-445-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC009753
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License Number State | PA
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