Provider Demographics
NPI:1144563438
Name:DECLEMENTE, THOMAS MARIO (ND)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MARIO
Last Name:DECLEMENTE
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1063 MARLBORO RD
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-9705
Mailing Address - Country:US
Mailing Address - Phone:802-380-9112
Mailing Address - Fax:
Practice Address - Street 1:1063 MARLBORO RD
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-9705
Practice Address - Country:US
Practice Address - Phone:802-380-9112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091.0091994171100000X
VT099.0091947175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist