Provider Demographics
NPI:1437444015
Name:RESTORED BALANCE INTEGRATED HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:RESTORED BALANCE INTEGRATED HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:BRUCK
Authorized Official - Suffix:
Authorized Official - Credentials:NCTMB, CLT
Authorized Official - Phone:717-495-2802
Mailing Address - Street 1:924 COLONIAL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3450
Mailing Address - Country:US
Mailing Address - Phone:717-495-2802
Mailing Address - Fax:717-718-5299
Practice Address - Street 1:924 COLONIAL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3450
Practice Address - Country:US
Practice Address - Phone:717-495-2802
Practice Address - Fax:717-718-5299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty