Provider Demographics
NPI:1881941342
Name:HEALTHY BALANCE NATURAL MEDICINE, PLLC
Entity type:Organization
Organization Name:HEALTHY BALANCE NATURAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:425-258-4633
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:888-431-8819
Practice Address - Street 1:2804 GRAND AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3430
Practice Address - Country:US
Practice Address - Phone:425-258-4633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHY BALANCE NATURAL MEDICINE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-14
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site