Provider Demographics
NPI:1659816635
Name:BALANCED INTEGRATIVE HEALTH
Entity Type:Organization
Organization Name:BALANCED INTEGRATIVE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORIENTAL MEDICINE, ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MONIEA SKLUZACEK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:320-980-7851
Mailing Address - Street 1:805 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063-1660
Mailing Address - Country:US
Mailing Address - Phone:320-629-5288
Mailing Address - Fax:320-629-8589
Practice Address - Street 1:805 MAIN ST S
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063-1660
Practice Address - Country:US
Practice Address - Phone:320-629-5288
Practice Address - Fax:320-629-8589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1816171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty