Provider Demographics
NPI:1942477385
Name:KANOKY, LLC
Entity Type:Organization
Organization Name:KANOKY, LLC
Other - Org Name:SECRET BALANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-943-2940
Mailing Address - Street 1:1321 E NORTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4218
Mailing Address - Country:US
Mailing Address - Phone:602-943-2940
Mailing Address - Fax:602-997-2494
Practice Address - Street 1:1321 E NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4218
Practice Address - Country:US
Practice Address - Phone:602-943-2940
Practice Address - Fax:602-997-2494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175L00000XOther Service ProvidersHomeopathGroup - Multi-Specialty