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General NPI Number Information
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NPI Number | 1295594042
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Entity Type | Organization
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Legal Business Name | TRI-STATE INTEGRATIVE MEDICINE, LLC
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Dates
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Enumeration Date | 03/14/2024
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Last Update Date | 03/14/2024
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Provider Practice Location Address
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Address Line | 1352 STAGE RD
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City | GUILFORD
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State | VT
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Zip | 05301-8730
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Country | US
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Telephone | 802-302-3747
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Fax |
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Provider Business Mailing Address
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Address Line | 1352 STAGE RD
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City | GUILFORD
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State | VT
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Zip | 05301-8730
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Country | US
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Telephone | 802-302-3747
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. BRENTON MURPHY
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Credential | ND, MPH
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Telephone | 802-302-3747
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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 |
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License Number State |
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