Provider Demographics
NPI:1063642049
Name:BALASSI, DANA C (DIPLOM, LAC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:C
Last Name:BALASSI
Suffix:
Gender:F
Credentials:DIPLOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-8627
Mailing Address - Country:US
Mailing Address - Phone:206-579-8267
Mailing Address - Fax:518-357-8111
Practice Address - Street 1:82 WOODLAWN AVE APT 2
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2107
Practice Address - Country:US
Practice Address - Phone:206-579-8267
Practice Address - Fax:518-357-8111
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA171100000X
NY004758171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist