Provider Demographics
NPI:1295128908
Name:BALANCED WELLNESS LLC
Entity type:Organization
Organization Name:BALANCED WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:NIZNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-709-7912
Mailing Address - Street 1:1966 NE 123RD ST
Mailing Address - Street 2:SUITE #223
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2868
Mailing Address - Country:US
Mailing Address - Phone:786-709-7912
Mailing Address - Fax:
Practice Address - Street 1:1966 NE 123RD ST
Practice Address - Street 2:SUITE #223
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2868
Practice Address - Country:US
Practice Address - Phone:786-709-7912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty