Healthcare Provider Details

I. General information

NPI: 1316132848
Provider Name (Legal Business Name): THE CONSCIOUS ESCAPE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 SHIRLEY ST NE
ALBUQUERQUE NM
87112-5649
US

IV. Provider business mailing address

1014 SHIRLEY ST NE
ALBUQUERQUE NM
87112-5649
US

V. Phone/Fax

Practice location:
  • Phone: 505-298-2927
  • Fax: 505-294-8397
Mailing address:
  • Phone: 505-298-2927
  • Fax: 505-294-8397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number705
License Number StateNM

VIII. Authorized Official

Name: BARBARA J. KNIGHTON
Title or Position: PRESIDENT
Credential: D.O.M.
Phone: 505-298-2927