Provider Demographics
NPI:1093177362
Name:INNER BALANCE MEDICINE
Entity Type:Organization
Organization Name:INNER BALANCE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:209-369-5008
Mailing Address - Street 1:801 S HAM LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-7501
Mailing Address - Country:US
Mailing Address - Phone:209-369-5008
Mailing Address - Fax:209-289-0058
Practice Address - Street 1:801 S HAM LN
Practice Address - Street 2:SUITE B
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-7501
Practice Address - Country:US
Practice Address - Phone:209-369-5008
Practice Address - Fax:209-289-0058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15323171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty