| NPI | 1558958991 |
|---|---|
| Doing Business As | TIDAL BALANCED WELLNESS CENTER |
| Entity Type | Organization |
| Authorized Contact | SHANNON BARELLO CRAYTON Owner 757-921-7704 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261Q00000X |
| Enumeration Date | 2020-12-30 |
| Last Update Date | 2024-04-10 |