Provider Demographics
NPI:1225326739
Name:INTEGRATIVE ACUPUNCTURE AND ORIENTAL MEDICINE LLC
Entity Type:Organization
Organization Name:INTEGRATIVE ACUPUNCTURE AND ORIENTAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-223-0954
Mailing Address - Street 1:156 MAIN ST
Mailing Address - Street 2:103
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602
Mailing Address - Country:US
Mailing Address - Phone:802-223-0954
Mailing Address - Fax:802-223-6057
Practice Address - Street 1:156 MAIN ST
Practice Address - Street 2:103
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2702
Practice Address - Country:US
Practice Address - Phone:802-223-0954
Practice Address - Fax:802-223-6057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0910000203171100000X
171100000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty