Provider Demographics
NPI:1366795676
Name:EASTERN BALANCE ORIENTAL MEDICINE LLC
Entity type:Organization
Organization Name:EASTERN BALANCE ORIENTAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-922-8179
Mailing Address - Street 1:2539 S GESSNER RD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-2034
Mailing Address - Country:US
Mailing Address - Phone:713-922-8179
Mailing Address - Fax:832-843-0317
Practice Address - Street 1:2539 S GESSNER RD
Practice Address - Street 2:SUITE 15
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-2034
Practice Address - Country:US
Practice Address - Phone:713-922-8179
Practice Address - Fax:832-843-0317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00748171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty