Provider Demographics
NPI:1063978021
Name:PORT CITY INTEGRATIVE HEALTH LLC
Entity type:Organization
Organization Name:PORT CITY INTEGRATIVE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:NIPPES
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:978-893-6130
Mailing Address - Street 1:18 HIGHLAND AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3812
Mailing Address - Country:US
Mailing Address - Phone:978-255-4418
Mailing Address - Fax:888-516-4432
Practice Address - Street 1:18 HIGHLAND AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3812
Practice Address - Country:US
Practice Address - Phone:978-255-4418
Practice Address - Fax:888-516-4432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty