Provider Demographics
NPI:1295594042
Name:TRI-STATE INTEGRATIVE MEDICINE, LLC
Entity type:Organization
Organization Name:TRI-STATE INTEGRATIVE MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENTON
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:ND, MPH
Authorized Official - Phone:802-302-3747
Mailing Address - Street 1:1352 STAGE RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05301-8730
Mailing Address - Country:US
Mailing Address - Phone:802-302-3747
Mailing Address - Fax:
Practice Address - Street 1:1352 STAGE RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:VT
Practice Address - Zip Code:05301-8730
Practice Address - Country:US
Practice Address - Phone:802-302-3747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty