Provider Demographics
NPI:1245673433
Name:NEW HAMPSHIRE NATURAL HEALTH CLINIC
Entity type:Organization
Organization Name:NEW HAMPSHIRE NATURAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHIESON
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:603-623-6800
Mailing Address - Street 1:304 RIVERWAY PL
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6764
Mailing Address - Country:US
Mailing Address - Phone:603-623-6800
Mailing Address - Fax:603-623-6812
Practice Address - Street 1:304 RIVERWAY PL
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6764
Practice Address - Country:US
Practice Address - Phone:603-623-6800
Practice Address - Fax:603-623-6812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH522133V00000X
NH84175F00000X
NH49175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHMB2529141OtherDEA
NHMM2189199OtherDEA