Provider Demographics
NPI:1285338335
Name:BACK TO BALANCE HEALTH COACHING LLC
Entity type:Organization
Organization Name:BACK TO BALANCE HEALTH COACHING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:NBC-HWC
Authorized Official - Phone:631-974-1480
Mailing Address - Street 1:28 GRACE CT
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-3640
Mailing Address - Country:US
Mailing Address - Phone:631-974-1480
Mailing Address - Fax:
Practice Address - Street 1:28 GRACE CT
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-3640
Practice Address - Country:US
Practice Address - Phone:631-974-1480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-30
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty