Provider Demographics
NPI:1952842510
Name:POINT BALANCE ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:POINT BALANCE ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:L.AC
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:NORA
Authorized Official - Last Name:BLAZEK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:719-243-5480
Mailing Address - Street 1:1871 QUEENS CANYON CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3687
Mailing Address - Country:US
Mailing Address - Phone:719-243-5480
Mailing Address - Fax:
Practice Address - Street 1:9320 GRAND CORDERA PKWY
Practice Address - Street 2:SUITE 125
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-7003
Practice Address - Country:US
Practice Address - Phone:719-357-9448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002214171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty