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General NPI Number Information
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NPI Number | 1649865619
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Entity Type | Organization
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Legal Business Name | VIM ACUPUNCTURE AND INTEGRATED WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 03/02/2021
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Last Update Date | 04/09/2022
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Provider Practice Location Address
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Address Line | 87 ROYAL PALM PT
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City | VERO BEACH
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State | FL
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Zip | 32960-4253
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Country | US
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Telephone | 772-333-8647
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Fax | 772-264-3181
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Provider Business Mailing Address
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Address Line | PO BOX 280
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City | VERO BEACH
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State | FL
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Zip | 32961-0280
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Country | US
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Telephone | 772-774-7775
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Fax | 772-264-3181
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | KIM NETLING
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Credential | DOM, LAC
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Telephone | 772-333-8647
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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 |
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License Number State |
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