Provider Demographics
NPI:1780940916
Name:YOUR NATURAL DR LLC
Entity type:Organization
Organization Name:YOUR NATURAL DR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HESSBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:203-500-9191
Mailing Address - Street 1:30 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-6348
Mailing Address - Country:US
Mailing Address - Phone:203-500-9191
Mailing Address - Fax:203-783-9016
Practice Address - Street 1:2452 BLACK ROCK TPKE STE 7
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-2407
Practice Address - Country:US
Practice Address - Phone:203-549-1511
Practice Address - Fax:203-690-1522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000556171100000X
CT000476175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty