Organization
INNER BALANCE INTEGRATIVE MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN BORDIUK MD (OWNER)
(781) 454-9014
Entity
Organization
Contact information
Practice address
65 WALNUT ST, SUITE 380, WELLESLEY, MA 02481-2118
(781) 239-9900
(781) 239-9953
Mailing address
65 WALNUT ST, SUITE 380, WELLESLEY, MA 02481-2118
(781) 454-9014
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
77100
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22D2048592
CLIA CERTIFICATION
MA
Enumeration date
06/19/2012
Last updated
04/25/2013
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