Provider Demographics
NPI:1972887701
Name:BODY BALANCE ACUPUNCTURE & HERB CLINIC, PC
Entity Type:Organization
Organization Name:BODY BALANCE ACUPUNCTURE & HERB CLINIC, PC
Other - Org Name:BODY BALANCE ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEOUNG
Authorized Official - Middle Name:R
Authorized Official - Last Name:JEE
Authorized Official - Suffix:
Authorized Official - Credentials:OMD, LAC
Authorized Official - Phone:303-929-3331
Mailing Address - Street 1:5300 DTC PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3095
Mailing Address - Country:US
Mailing Address - Phone:303-929-3331
Mailing Address - Fax:720-282-0132
Practice Address - Street 1:5300 DTC PKWY STE 400
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-3095
Practice Address - Country:US
Practice Address - Phone:303-929-3331
Practice Address - Fax:720-282-0132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1232171100000X
CO7086225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty