Provider Demographics
NPI:1801202957
Name:BALANCENTRAL, LLC
Entity Type:Organization
Organization Name:BALANCENTRAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERR
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-871-7287
Mailing Address - Street 1:3000 MARKET ST NE STE 355
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1892
Mailing Address - Country:US
Mailing Address - Phone:503-871-7287
Mailing Address - Fax:
Practice Address - Street 1:3000 MARKET ST NE STE 355
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1892
Practice Address - Country:US
Practice Address - Phone:503-871-7287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19587225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty