Provider Demographics
NPI:1558654004
Name:BALANCED HEALTH ACUPUNCTURE, PC
Entity Type:Organization
Organization Name:BALANCED HEALTH ACUPUNCTURE, PC
Other - Org Name:KINDERHOOK HEALING ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:917-373-2466
Mailing Address - Street 1:12 JAMES LN
Mailing Address - Street 2:
Mailing Address - City:KINDERHOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12106-2313
Mailing Address - Country:US
Mailing Address - Phone:917-373-2466
Mailing Address - Fax:646-810-3957
Practice Address - Street 1:3001 MAIN STREET
Practice Address - Street 2:
Practice Address - City:VALATIE
Practice Address - State:NY
Practice Address - Zip Code:12184
Practice Address - Country:US
Practice Address - Phone:518-758-7711
Practice Address - Fax:646-810-3957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003118171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty