Provider Demographics
NPI:1871847707
Name:IN BALANCE ACUPUNCTURE & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:IN BALANCE ACUPUNCTURE & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CABRANES
Authorized Official - Suffix:
Authorized Official - Credentials:MSOM, LAC
Authorized Official - Phone:262-584-9955
Mailing Address - Street 1:5906 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-2738
Mailing Address - Country:US
Mailing Address - Phone:262-584-9955
Mailing Address - Fax:262-584-9956
Practice Address - Street 1:5906 39TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-2738
Practice Address - Country:US
Practice Address - Phone:262-584-9955
Practice Address - Fax:262-584-9956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
747-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty