Provider Demographics
NPI:1912132564
Name:BOOTH, CHRISTOPHER (LAC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
Last Name:BOOTH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:CHRISTOPHER
Other - Middle Name:
Other - Last Name:BOOTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:403 MCGRATH BLVD
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-2831
Mailing Address - Country:US
Mailing Address - Phone:845-242-4962
Mailing Address - Fax:
Practice Address - Street 1:403 MCGRATH BLVD
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2831
Practice Address - Country:US
Practice Address - Phone:845-242-4962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2019-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003874171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist