Provider Demographics
NPI:1508102740
Name:TLC REACH BALANCE MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:TLC REACH BALANCE MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TILING
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN-CHIANG
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:848-391-8686
Mailing Address - Street 1:PO BOX 3485
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-0348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5890 STONERIDGE DR UNIT 215
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-5818
Practice Address - Country:US
Practice Address - Phone:848-391-8686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA739628163W00000X
CAAC-15083171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty