Provider Demographics
NPI:1720206964
Name:CENTER OF INTEGRATED MEDICINE
Entity Type:Organization
Organization Name:CENTER OF INTEGRATED MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-752-4838
Mailing Address - Street 1:9050 58TH DR. E.
Mailing Address - Street 2:STE 101
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-6104
Mailing Address - Country:US
Mailing Address - Phone:941-752-4838
Mailing Address - Fax:
Practice Address - Street 1:9050 58TH DR E
Practice Address - Street 2:STE 101
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-6104
Practice Address - Country:US
Practice Address - Phone:941-752-4838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2217171100000X
FLAP2238171100000X
FLAP2220171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty