Provider Demographics
NPI:1679881882
Name:PALMETTO BALANCE HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:PALMETTO BALANCE HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NUTRITIONIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-661-0211
Mailing Address - Street 1:1506 2ND LOOP RD STE A
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-2845
Mailing Address - Country:US
Mailing Address - Phone:843-661-0211
Mailing Address - Fax:843-661-0213
Practice Address - Street 1:1506 2ND LOOP RD STE A
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-2845
Practice Address - Country:US
Practice Address - Phone:843-661-0211
Practice Address - Fax:843-661-0213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty