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General NPI Number Information
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NPI Number | 1114476983
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Entity Type | Organization
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Legal Business Name | NATUROPATHIC
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 09/22/2016
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Provider Practice Location Address
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Address Line | 250 W MAIN ST SUITE W226
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City | BRANFORD
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State | CT
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Zip | 06405-4032
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Country | US
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Telephone | 203-315-6246
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Fax | 203-315-6248
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Provider Business Mailing Address
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Address Line | 250 W MAIN ST SUITE W226
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City | BRANFORD
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State | CT
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Zip | 06405-4032
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Country | US
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Telephone | 203-315-6246
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Fax | 203-315-6248
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Authorized Official
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Title or Position | OWNER
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Name | DR. JASMINE K MANNING
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Credential | ND
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Telephone | 203-315-6246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 000524
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License Number State | CT
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