Provider Demographics
NPI:1821613944
Name:IDEAL BALANCE PLLC
Entity Type:Organization
Organization Name:IDEAL BALANCE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDNENT/MD
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:ALLGAIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-222-1275
Mailing Address - Street 1:5615 DUNBARTON AVE
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-8216
Mailing Address - Country:US
Mailing Address - Phone:509-570-9302
Mailing Address - Fax:509-491-3031
Practice Address - Street 1:1443 IDAHO ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2558
Practice Address - Country:US
Practice Address - Phone:877-522-1275
Practice Address - Fax:509-491-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health