Healthcare Provider Details

I. General information

NPI: 1174718332
Provider Name (Legal Business Name): BODYMINDSPIRIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12165 HWY 14 N SUITE B-7
CEDAR CREST NM
87008-9461
US

IV. Provider business mailing address

12165 HWY 14 N SUITE B-7
CEDAR CREST NM
87008-9461
US

V. Phone/Fax

Practice location:
  • Phone: 505-281-8446
  • Fax: 505-281-3099
Mailing address:
  • Phone: 505-281-8446
  • Fax: 505-281-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number640
License Number StateNM

VIII. Authorized Official

Name: STEPHEN LAJOIE
Title or Position: PARTNER
Credential: D.O.M.
Phone: 505-281-8446