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General NPI Number Information
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NPI Number | 1033742481
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Entity Type | Organization
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Legal Business Name | INDIGO WELLNESS GROUP LLC
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Dates
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Enumeration Date | 02/13/2020
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Last Update Date | 12/15/2023
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Provider Practice Location Address
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Address Line | 144 MORGAN ST STE 1
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City | STAMFORD
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State | CT
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Zip | 06905-5433
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Country | US
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Telephone | 203-658-7850
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Fax |
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Provider Business Mailing Address
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Address Line | 66 GLENBROOK RD STE 300
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City | STAMFORD
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State | CT
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Zip | 06902-8402
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/ ACUPUNCTURIST
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Name | SARAH SWANBERG
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Credential | LAC
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Telephone | 203-658-7850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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