Provider Demographics
NPI:1407175706
Name:AIM100NUTRITION, LLC
Entity Type:Organization
Organization Name:AIM100NUTRITION, LLC
Other - Org Name:AIM100NUTRITION.COM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DORVILUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-649-6944
Mailing Address - Street 1:272 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-3536
Mailing Address - Country:US
Mailing Address - Phone:860-649-6944
Mailing Address - Fax:
Practice Address - Street 1:272 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-3536
Practice Address - Country:US
Practice Address - Phone:860-649-6944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty