Provider Demographics
NPI:1396149100
Name:BALANCED HEALTH ACUPUNCTURE CENTER, LLC
Entity type:Organization
Organization Name:BALANCED HEALTH ACUPUNCTURE CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUJAN
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, LAC
Authorized Official - Phone:505-454-0003
Mailing Address - Street 1:PO BOX 2183
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-2183
Mailing Address - Country:US
Mailing Address - Phone:505-454-0003
Mailing Address - Fax:505-910-4665
Practice Address - Street 1:338 SANTA ANA ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-3758
Practice Address - Country:US
Practice Address - Phone:505-454-0003
Practice Address - Fax:505-910-4665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
NM1141171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1141OtherSTATE LICENSE