Provider Demographics
NPI:1871610444
Name:SIMPLE RELIEF HEALTH & WELLNESS CENTER LLC
Entity type:Organization
Organization Name:SIMPLE RELIEF HEALTH & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BALEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, ND
Authorized Official - Phone:941-363-9000
Mailing Address - Street 1:625 N WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-4241
Mailing Address - Country:US
Mailing Address - Phone:941-363-9000
Mailing Address - Fax:941-951-1808
Practice Address - Street 1:625 N WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-4241
Practice Address - Country:US
Practice Address - Phone:941-363-9000
Practice Address - Fax:941-951-1808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7535111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74909OtherBCBS GROUP NUMBER
FLCH7535OtherFLORIDA MEDICAL LICENSE
FL74909OtherBCBS GROUP NUMBER
FLCH7535OtherFLORIDA MEDICAL LICENSE