Healthcare Provider Details

I. General information

NPI: 1649865619
Provider Name (Legal Business Name): VIM ACUPUNCTURE AND INTEGRATED WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 04/09/2022
Certification Date: 04/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 ROYAL PALM PT
VERO BEACH FL
32960-4253
US

IV. Provider business mailing address

PO BOX 280
VERO BEACH FL
32961-0280
US

V. Phone/Fax

Practice location:
  • Phone: 772-333-8647
  • Fax: 772-264-3181
Mailing address:
  • Phone: 772-774-7775
  • Fax: 772-264-3181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KIM NETLING
Title or Position: REGISTERED AGENT
Credential: DOM, LAC
Phone: 772-333-8647