Provider Demographics
NPI:1952630774
Name:FULL SPECTRUM ENERGY MEDICINE, INC.
Entity Type:Organization
Organization Name:FULL SPECTRUM ENERGY MEDICINE, INC.
Other - Org Name:FULL SPECTRUM WELLNESS, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SAUTER
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:610-275-3371
Mailing Address - Street 1:1210 CHERRY LANE
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1802
Mailing Address - Country:US
Mailing Address - Phone:610-275-3371
Mailing Address - Fax:610-277-0347
Practice Address - Street 1:1210 CHERRY LANE
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1802
Practice Address - Country:US
Practice Address - Phone:610-275-3371
Practice Address - Fax:610-277-0347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA8000000590174400000X
DCNAT1000568175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA8000000590OtherPA DEPT. OF HEALTH