Provider Demographics
NPI:1720314032
Name:THE NATURAL MEDICINE CLINIC LLC
Entity Type:Organization
Organization Name:THE NATURAL MEDICINE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JUDE
Authorized Official - Last Name:LOQUASTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-310-4252
Mailing Address - Street 1:2571 BAGLYOS CIR
Mailing Address - Street 2:SUITE B 27
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-8045
Mailing Address - Country:US
Mailing Address - Phone:908-310-4252
Mailing Address - Fax:908-475-4966
Practice Address - Street 1:2571 BAGLYOS CIR
Practice Address - Street 2:SUITE B 27
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8045
Practice Address - Country:US
Practice Address - Phone:908-310-4252
Practice Address - Fax:908-475-4966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001064L111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty