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General NPI Number Information
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NPI Number | 1720206964
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Entity Type | Organization
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Legal Business Name | CENTER OF INTEGRATED MEDICINE
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9050 58TH DR E STE 101
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City | BRADENTON
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State | FL
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Zip | 34202-6104
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Country | US
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Telephone | 941-752-4838
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Fax |
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Provider Business Mailing Address
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Address Line | 9050 58TH DR. E. STE 101
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City | BRADENTON
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State | FL
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Zip | 34202-6104
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Country | US
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Telephone | 941-752-4838
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | OWEN MARRON
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Credential |
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Telephone | 941-752-4838
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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 | AP2238
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP2220
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP2217
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License Number State | FL
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