Provider Demographics
NPI:1609053057
Name:LIVING IN BALANCE HEALTH CENTER, P.A.
Entity Type:Organization
Organization Name:LIVING IN BALANCE HEALTH CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAJCHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-896-1658
Mailing Address - Street 1:PO BOX 1139
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:NH
Mailing Address - Zip Code:03077-1139
Mailing Address - Country:US
Mailing Address - Phone:603-895-1658
Mailing Address - Fax:603-895-9394
Practice Address - Street 1:74 MAIN STREET
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:NH
Practice Address - Zip Code:03077
Practice Address - Country:US
Practice Address - Phone:603-895-1658
Practice Address - Fax:603-895-9394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH026553-23-03363LF0000X
NH033294-21363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty