Provider Demographics
NPI:1922498872
Name:CENTER FOR NATURAL MEDICINE, LLC
Entity Type:Organization
Organization Name:CENTER FOR NATURAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAISTRICK
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:860-945-1004
Mailing Address - Street 1:640 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2614
Mailing Address - Country:US
Mailing Address - Phone:860-945-1004
Mailing Address - Fax:
Practice Address - Street 1:640 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2614
Practice Address - Country:US
Practice Address - Phone:860-945-1004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000124175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty