Provider Demographics
NPI:1134368699
Name:VACHON, DIANA K (LIC AC)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:K
Last Name:VACHON
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 LAPLATTE CIR APT 5
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-6217
Mailing Address - Country:US
Mailing Address - Phone:802-985-5083
Mailing Address - Fax:
Practice Address - Street 1:167 PEARL ST
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-3068
Practice Address - Country:US
Practice Address - Phone:802-879-7999
Practice Address - Fax:802-878-7888
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091-0000224171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist