Provider Demographics
NPI:1902574585
Name:BALANCEDLIFE
Entity Type:Organization
Organization Name:BALANCEDLIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:808-834-5004
Mailing Address - Street 1:PO BOX 942
Mailing Address - Street 2:
Mailing Address - City:MT VIEW
Mailing Address - State:HI
Mailing Address - Zip Code:96720
Mailing Address - Country:US
Mailing Address - Phone:808-345-0047
Mailing Address - Fax:808-207-9478
Practice Address - Street 1:750 KANOELEHUA AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-7524
Practice Address - Country:US
Practice Address - Phone:808-345-0047
Practice Address - Fax:808-207-9478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty