Provider Demographics
NPI:1720353360
Name:CONCORD NATUROPATHIC CLINIC
Entity Type:Organization
Organization Name:CONCORD NATUROPATHIC CLINIC
Other - Org Name:DBA NEW ENGLAND INTEGRATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:603-458-6579
Mailing Address - Street 1:23 STILES ROAD
Mailing Address - Street 2:STE 210
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079
Mailing Address - Country:US
Mailing Address - Phone:603-458-6579
Mailing Address - Fax:603-328-8155
Practice Address - Street 1:23 STILES ROAD
Practice Address - Street 2:STE 210
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079
Practice Address - Country:US
Practice Address - Phone:603-458-6579
Practice Address - Fax:603-328-8155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH76175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty