Healthcare Provider Details

I. General information

NPI: 1720353360
Provider Name (Legal Business Name): CONCORD NATUROPATHIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 STILES ROAD STE 210
SALEM NH
03079
US

IV. Provider business mailing address

23 STILES ROAD STE 210
SALEM NH
03079
US

V. Phone/Fax

Practice location:
  • Phone: 603-458-6579
  • Fax: 603-328-8155
Mailing address:
  • Phone: 603-458-6579
  • Fax: 603-328-8155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number76
License Number StateNH

VIII. Authorized Official

Name: DR. JACQUELINE YANG
Title or Position: OWNER
Credential: N.D.
Phone: 603-458-6579