Provider Demographics
NPI:1962801696
Name:IBALANCE WELLNESS LLC
Entity type:Organization
Organization Name:IBALANCE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NIESJE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUAAS
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD, CDE
Authorized Official - Phone:972-835-5216
Mailing Address - Street 1:5900 S LAKE FOREST DR STE 300
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2238
Mailing Address - Country:US
Mailing Address - Phone:972-835-5216
Mailing Address - Fax:
Practice Address - Street 1:5900 S LAKE FOREST DR STE 300
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2238
Practice Address - Country:US
Practice Address - Phone:972-835-5216
Practice Address - Fax:972-727-9238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty