Provider Demographics
NPI:1245784537
Name:BODY BALANCE HOLISTICS
Entity Type:Organization
Organization Name:BODY BALANCE HOLISTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:626-780-3015
Mailing Address - Street 1:1132 HUNTINGTON DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-2451
Mailing Address - Country:US
Mailing Address - Phone:818-940-1168
Mailing Address - Fax:
Practice Address - Street 1:601 N AVALON BLVD STE A
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-5871
Practice Address - Country:US
Practice Address - Phone:818-940-1168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty