Healthcare Provider Details

I. General information

NPI: 1144480880
Provider Name (Legal Business Name): NATURAL BALANCE ACUPUNCTURE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 JUAN DE JESUS CT NE
LOS LUNAS NM
87031-4900
US

IV. Provider business mailing address

924 JUAN DE JESUS CT NE P.O. BOX 1016
LOS LUNAS NM
87031-4900
US

V. Phone/Fax

Practice location:
  • Phone: 505-400-8962
  • Fax:
Mailing address:
  • Phone: 505-400-8962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number971
License Number StateNM

VIII. Authorized Official

Name: DR. MICHELE R LOUISELLE
Title or Position: OWNER
Credential: DOM, DIPL, OM
Phone: 505-400-8962