Healthcare Provider Details

I. General information

NPI: 1447414065
Provider Name (Legal Business Name): BIOLOGIC INTEGRATIVE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2008
Last Update Date: 07/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MAIN ST SUITE 4
BRATTLEBORO VT
05301-2867
US

IV. Provider business mailing address

205 MAIN ST SUITE 4
BRATTLEBORO VT
05301-2867
US

V. Phone/Fax

Practice location:
  • Phone: 802-275-4732
  • Fax:
Mailing address:
  • Phone: 802-275-4732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA K EAGLE
Title or Position: SOLE MEMBER/OWNER
Credential:
Phone: 802-275-4732