| Organization Name: | NEW BALANCE LAKE ST. LOUIS |
| NPI Number: | 1114165263 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHAD LOUIS BROWN (CERTIFIED PEDORTHIST) |
| Mailing Address: | 21 Meadows Circle Dr Suite 314 Lake St Louis |
| State: | MO US |
| Postal Code: | 633674109 |
| Phone Number: | 6365612204 |
| Fax Number: | 6366252611 |
| NPI Enumeration Date: | 01/28/2009 |
| NPI Last Update Date: | 01/28/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 013370 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |