=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497263396
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CRAIG A CAMMANN LAC., DAC, DIPL. AC,
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2018
-----------------------------------------------------
Last Update Date | 04/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11 N MAIN ST STE 102
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05676-1869
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-560-8818
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 N MAIN ST STE 102
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05676-1869
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-560-8818
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 006482
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 029697
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------