Provider Demographics
NPI:1659746972
Name:ESSENTIAL BALANCE, LLC
Entity Type:Organization
Organization Name:ESSENTIAL BALANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:E
Authorized Official - Last Name:UNCAPHER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, MMP, CIMI
Authorized Official - Phone:302-545-1926
Mailing Address - Street 1:1450 CAPITOL TRAIL SHOPS AT RED MILL
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711
Mailing Address - Country:US
Mailing Address - Phone:302-861-6353
Mailing Address - Fax:
Practice Address - Street 1:1450 CAPITOL TRAIL
Practice Address - Street 2:SUITE 104
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711
Practice Address - Country:US
Practice Address - Phone:302-861-6353
Practice Address - Fax:302-525-6591
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ESSENTIAL BALANCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-11
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2017600206225700000X
DEMT-0003855225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty