Healthcare Provider Details

I. General information

NPI: 1194142596
Provider Name (Legal Business Name): ESSENTIAL NATURAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WADSWORTH DR
NORTH CHESTERFIELD VA
23236-4525
US

IV. Provider business mailing address

235 WADSWORTH DR
NORTH CHESTERFIELD VA
23236-4525
US

V. Phone/Fax

Practice location:
  • Phone: 804-464-3315
  • Fax:
Mailing address:
  • Phone: 804-464-3315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: MICAH MARAHIA JACKSON ALLEN
Title or Position: OWNER
Credential: ND, LAC
Phone: 804-464-3315