Healthcare Provider Details

I. General information

NPI: 1821508169
Provider Name (Legal Business Name): ROOT CAUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2017
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 WHITNEY AVE
NEW HAVEN CT
06510-1226
US

IV. Provider business mailing address

422 TOILSOME HILL RD
FAIRFIELD CT
06825-1627
US

V. Phone/Fax

Practice location:
  • Phone: 203-865-5121
  • Fax:
Mailing address:
  • Phone: 12036739600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number583
License Number StateCT

VIII. Authorized Official

Name: JOSHUA SHAIN
Title or Position: MANAGER
Credential: MSAOM L.AC.
Phone: 203-673-9600