Healthcare Provider Details

I. General information

NPI: 1003441056
Provider Name (Legal Business Name): NIKHIL RAMBURN DAOM, L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 BANTAM RD
BANTAM CT
06750-1600
US

IV. Provider business mailing address

622 BANTAM RD
BANTAM CT
06750-1600
US

V. Phone/Fax

Practice location:
  • Phone: 802-373-2352
  • Fax:
Mailing address:
  • Phone: 802-373-2352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: