Healthcare Provider Details

I. General information

NPI: 1477017747
Provider Name (Legal Business Name): BIOELECTRO MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 FIR LOOP
CEDAR CREST NM
87008-9468
US

IV. Provider business mailing address

14 FIR LOOP
CEDAR CREST NM
87008-9468
US

V. Phone/Fax

Practice location:
  • Phone: 505-506-1230
  • Fax: 505-212-1087
Mailing address:
  • Phone: 505-506-1230
  • Fax: 505-212-1087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN E BENNETT
Title or Position: MEMBER
Credential: DOM
Phone: 505-363-1428