Healthcare Provider Details

I. General information

NPI: 1134368699
Provider Name (Legal Business Name): DIANA K. VACHON LIC. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 02/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 PEARL ST
ESSEX JUNCTION VT
05452-3068
US

IV. Provider business mailing address

180 LAPLATTE CIR APT 5
SHELBURNE VT
05482-6217
US

V. Phone/Fax

Practice location:
  • Phone: 802-879-7999
  • Fax: 802-878-7888
Mailing address:
  • Phone: 802-985-5083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number091-0000224
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: