Healthcare Provider Details

I. General information

NPI: 1295594042
Provider Name (Legal Business Name): TRI-STATE INTEGRATIVE MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1352 STAGE RD
GUILFORD VT
05301-8730
US

IV. Provider business mailing address

1352 STAGE RD
GUILFORD VT
05301-8730
US

V. Phone/Fax

Practice location:
  • Phone: 802-302-3747
  • Fax:
Mailing address:
  • Phone: 802-302-3747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: DR. BRENTON MURPHY
Title or Position: DOCTOR
Credential: ND, MPH
Phone: 802-302-3747