Provider Demographics
NPI:1730451493
Name:IDEAL BALANCE, INC.
Entity type:Organization
Organization Name:IDEAL BALANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:AP DOM LMT
Authorized Official - Phone:813-766-1319
Mailing Address - Street 1:9613 N 55TH ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-4723
Mailing Address - Country:US
Mailing Address - Phone:813-766-1319
Mailing Address - Fax:888-440-0629
Practice Address - Street 1:10927 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-3000
Practice Address - Country:US
Practice Address - Phone:813-766-1319
Practice Address - Fax:888-440-0629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3036171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty