Provider Demographics
NPI:1902923246
Name:BALANCE IN LIFE PLC
Entity Type:Organization
Organization Name:BALANCE IN LIFE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D. OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THADDEUS
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:SRUTWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-847-5154
Mailing Address - Street 1:17206 VAN WAGONER RD
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-9702
Mailing Address - Country:US
Mailing Address - Phone:616-847-5154
Mailing Address - Fax:616-842-1949
Practice Address - Street 1:17206 VAN WAGONER RD
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-9702
Practice Address - Country:US
Practice Address - Phone:616-847-5154
Practice Address - Fax:616-842-1949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045363204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION90970OtherMEDICARE GROUP
MI0700125OtherBLUE CROSS BLUE SHIELD
MI1902923246OtherNPI FOR BALANCE IN LIFE