Healthcare Provider Details

I. General information

NPI: 1447649702
Provider Name (Legal Business Name): WESTSIDE ACUPUNCTURE & MASSAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4824 MCMAHON BLVD NW STE 113
ALBUQUERQUE NM
87114-5412
US

IV. Provider business mailing address

6119 MUSTANG LN NW
ALBUQUERQUE NM
87120-2289
US

V. Phone/Fax

Practice location:
  • Phone: 505-890-9378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number869
License Number StateNM

VIII. Authorized Official

Name: BRIAN CAREY
Title or Position: OWNER
Credential: DOM
Phone: 505-890-9378