Provider Demographics
NPI:1972839264
Name:ABSOLUTE COMPLEMENTARY MEDICINE LLC
Entity Type:Organization
Organization Name:ABSOLUTE COMPLEMENTARY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-501-1249
Mailing Address - Street 1:3740 20TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-2418
Mailing Address - Country:US
Mailing Address - Phone:772-766-4418
Mailing Address - Fax:
Practice Address - Street 1:3740 20TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-2418
Practice Address - Country:US
Practice Address - Phone:772-766-4418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2563171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty