Healthcare Provider Details

I. General information

NPI: 1831631480
Provider Name (Legal Business Name): SHAWN WEEKS DOM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 CARLISLE BLVD NE
ALBUQUERQUE NM
87107-4532
US

IV. Provider business mailing address

4010 CARLISLE BLVD NE
ALBUQUERQUE NM
87107-4532
US

V. Phone/Fax

Practice location:
  • Phone: 505-239-1268
  • Fax:
Mailing address:
  • Phone: 505-239-1268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1186
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: