13D2099989 CLIA NUMBER - IN BALANCE INTEGRATIVE PRIMARY HEALTHCARE

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Laboratory Demographics

CLIA Number: 13D2099989

Facility Name: IN BALANCE INTEGRATIVE PRIMARY HEALTHCARE

Facility Address:
1017 E YOUNG ST
POCATELLO, ID
ZIP 83201
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Facility Phone Number: (208) 425-6444

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1457839730

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	13D2099989
LAB Type	PHYSICIAN OFFICE
Facility Name	IN BALANCE INTEGRATIVE PRIMARY HEALTHCARE
Street	1017 E YOUNG ST
City	POCATELLO
State	ID
ZIP	83201
Phone	(208) 425-6444

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This page was last updated on: 5/11/2023