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General NPI Number Information
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NPI Number | 1588158844
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Entity Type | Organization
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Legal Business Name | ARCH CLINIC OF ACUPUNCTURE & HERBAL MEDICINE, PLLC
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 83 WESTERN AVE
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City | BRATTLEBORO
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State | VT
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Zip | 05301-6090
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Country | US
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Telephone | 802-451-6700
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Fax | 802-448-1645
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Provider Business Mailing Address
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Address Line | 83 WESTERN AVE
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City | BRATTLEBORO
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State | VT
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Zip | 05301-6090
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Country | US
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Telephone | 802-451-6700
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Fax | 802-448-1645
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Authorized Official
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Title or Position | MGR/OWNER
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Name | JOANNA BOUTZOUKAS
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Credential | L.AC. MATCM, DIPL.OM
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Telephone | 802-451-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 091.0134003
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License Number State | VT
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