Healthcare Provider Details

I. General information

NPI: 1932539533
Provider Name (Legal Business Name): WHOLE HEALTH CONCORD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 N STATE ST SUITE 102
CONCORD NH
03301-4300
US

IV. Provider business mailing address

91 N STATE ST SUITE 102
CONCORD NH
03301-4300
US

V. Phone/Fax

Practice location:
  • Phone: 603-369-4626
  • Fax: 603-369-4627
Mailing address:
  • Phone: 603-369-4626
  • Fax: 603-369-4627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1486
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number92
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number91
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number4045M
License Number StateNH
# 5
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number51
License Number StateNH

VIII. Authorized Official

Name: MS. LAURA A JONES
Title or Position: OWNER/ CEO
Credential: N.D.
Phone: 603-369-4626