Provider Demographics
NPI:1437749660
Name:PRECISION INTEGRATIVE MEDICINE, LLC
Entity Type:Organization
Organization Name:PRECISION INTEGRATIVE MEDICINE, LLC
Other - Org Name:PRECISION INTEGRATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACUPUNCTURE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PMD, DIPL OM, AP
Authorized Official - Phone:352-901-4513
Mailing Address - Street 1:877 W MINNEOLA AVE # 121262
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34712-1262
Mailing Address - Country:US
Mailing Address - Phone:352-901-4513
Mailing Address - Fax:
Practice Address - Street 1:835 7TH ST STE 1
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2190
Practice Address - Country:US
Practice Address - Phone:352-901-4513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty