Healthcare Provider Details

I. General information

NPI: 1871764688
Provider Name (Legal Business Name): ACUPUNCTURE ETC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SPAIN RD NE BLDG E
ALBUQUERQUE NM
87111
US

IV. Provider business mailing address

PO BOX 91871
ALBUQUERQUE NM
87199-1871
US

V. Phone/Fax

Practice location:
  • Phone: 505-264-0024
  • Fax:
Mailing address:
  • Phone: 505-264-0024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number822
License Number StateNM

VIII. Authorized Official

Name: CONSTANCE J GEHRING
Title or Position: OWNER
Credential: DOM
Phone: 505-264-0024