Provider Demographics
NPI:1104368604
Name:ROOTED SPIRIT ACUPUNCTURE
Entity Type:Organization
Organization Name:ROOTED SPIRIT ACUPUNCTURE
Other - Org Name:KATE MCCARTHY, LIC AC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:LIC AC
Authorized Official - Phone:978-407-6075
Mailing Address - Street 1:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:STODDARD
Mailing Address - State:NH
Mailing Address - Zip Code:03464-0264
Mailing Address - Country:US
Mailing Address - Phone:603-213-3748
Mailing Address - Fax:
Practice Address - Street 1:7 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-2417
Practice Address - Country:US
Practice Address - Phone:603-213-3748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH246171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty