MEDICARE: REBALANCE BIOHEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1497146336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REBALANCE BIOHEALTH LLC

Provider Business Mailing Address
First Line	:	8400 E CRESCENT PKWY
Second Line	:	SUITE 600
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-2831
Country	:	US
Telephone Number	:	817-791-2775
Fax Number	:

Provider Business Practice Location Address
First Line	:	8400 E CRESCENT PKWY
Second Line	:	SUITE 600
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-2831
Country	:	US
Telephone Number	:	817-791-2775
Fax Number	:

Authorized Official
Title or Position	:	EVP NEW BUSINESS INITIATIVES
Name	:	MR. DON C PURDY
Credential	:
Telephone Number	:	817-791-2775

Provider Enumeration Date	:	02/13/2015
Last Update Date	:	02/13/2015

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