Healthcare Provider Details

I. General information

NPI: 1477796308
Provider Name (Legal Business Name): JEMEZ HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 04/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 CARLISLE BLVD NE SUITE B
ALBUQUERQUE NM
87107-4532
US

IV. Provider business mailing address

4010 CARLISLE BLVD NE SUITE B
ALBUQUERQUE NM
87107-4532
US

V. Phone/Fax

Practice location:
  • Phone: 505-220-2321
  • Fax:
Mailing address:
  • Phone: 505-220-2321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number730
License Number StateNM

VIII. Authorized Official

Name: DR. JOHN HEUERTZ
Title or Position: OWNER
Credential: D.O.M., L.AC.
Phone: 505-220-2321