Healthcare Provider Details

I. General information

NPI: 1578743068
Provider Name (Legal Business Name): CONSCIOUS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 STATE ROAD 150 STE 5 HC74 BOX 24813
EL PRADO NM
87529
US

IV. Provider business mailing address

98 STATE ROAD 150 STE 5 HC74 BOX 24813
EL PRADO NM
87529
US

V. Phone/Fax

Practice location:
  • Phone: 575-776-8012
  • Fax:
Mailing address:
  • Phone: 575-776-8012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number931
License Number StateNM

VIII. Authorized Official

Name: DR. RICHARD A CONNELL
Title or Position: OFFICER
Credential: DOM
Phone: 575-776-8012