Provider Demographics
NPI:1609414572
Name:INNER BALANCE MEDICINE, ACUPUNCTURE CORP
Entity Type:Organization
Organization Name:INNER BALANCE MEDICINE, ACUPUNCTURE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:209-570-0486
Mailing Address - Street 1:801 S HAM LN STE B
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-7502
Mailing Address - Country:US
Mailing Address - Phone:209-369-5008
Mailing Address - Fax:209-713-4680
Practice Address - Street 1:1121 W VINE ST STE 15
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-5137
Practice Address - Country:US
Practice Address - Phone:209-369-5008
Practice Address - Fax:209-713-4680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC4263823OtherARTICLES OF INCORPORATION