| Organization Name: | THE ICON FOR BALANCED HEALTH, LLC |
| NPI Number: | 1730335977 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN ROBERT JOHNSTON (MEDICAL DIRECTOR) |
| Mailing Address: | 250 Blossom St Suite 100 Webster |
| State: | TX US |
| Postal Code: | 775984204 |
| Phone Number: | 2817240190 |
| Fax Number: | 2817240191 |
| NPI Enumeration Date: | 08/07/2008 |
| NPI Last Update Date: | 08/08/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |