Healthcare Provider Details

I. General information

NPI: 1225453681
Provider Name (Legal Business Name): FOUR CORNERS ACUPUNCTURE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2014
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 MORRISTOWN CORNERS RD
MORRISVILLE VT
05661-8985
US

IV. Provider business mailing address

632 MORRISTOWN CORNERS RD
MORRISVILLE VT
05661-8985
US

V. Phone/Fax

Practice location:
  • Phone: 802-585-5510
  • Fax:
Mailing address:
  • Phone: 802-585-5510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0910073477
License Number StateVT

VIII. Authorized Official

Name: KATIE R CHIVINGTON
Title or Position: OWNER
Credential: LAC
Phone: 802-585-5510