Provider Demographics
NPI:1376080770
Name:REBALANCE WELLNESS CENTERS
Entity Type:Organization
Organization Name:REBALANCE WELLNESS CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-200-4277
Mailing Address - Street 1:3012 E HEBRON PKWY
Mailing Address - Street 2:SUITE 116
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4464
Mailing Address - Country:US
Mailing Address - Phone:214-200-4277
Mailing Address - Fax:
Practice Address - Street 1:3012 E HEBRON PKWY
Practice Address - Street 2:SUITE 116
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4464
Practice Address - Country:US
Practice Address - Phone:214-200-4277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty