Provider Demographics
NPI:1609079763
Name:CENTER FOR INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:CENTER FOR INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUCKSBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-747-7730
Mailing Address - Street 1:69 ALLEN ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4564
Mailing Address - Country:US
Mailing Address - Phone:802-747-7730
Mailing Address - Fax:802-773-1609
Practice Address - Street 1:69 ALLEN ST
Practice Address - Street 2:SUITE 9
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4564
Practice Address - Country:US
Practice Address - Phone:802-747-7730
Practice Address - Fax:802-773-1609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty