Provider Demographics
NPI:1215365358
Name:NATURAL BALANCE PAIN AND WELLNESS CENTER INC.
Entity type:Organization
Organization Name:NATURAL BALANCE PAIN AND WELLNESS CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DN
Authorized Official - Phone:815-603-9755
Mailing Address - Street 1:6409 SUNNY DAY CT NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-6144
Mailing Address - Country:US
Mailing Address - Phone:815-603-9755
Mailing Address - Fax:
Practice Address - Street 1:1258 ORTIZ DR SE
Practice Address - Street 2:301-303
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-4635
Practice Address - Country:US
Practice Address - Phone:815-603-9755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0021172P00000X
NMMD2007-0654207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172P00000XOther Service ProvidersNaprapathGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty