Healthcare Provider Details

I. General information

NPI: 1245578277
Provider Name (Legal Business Name): ACUPUNCTURE HEALING ALTERNATIVES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2013
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 FREDS LOOP BOX 1012
PEOCS NM
87552-1012
US

IV. Provider business mailing address

BOX 1012 16 FREDS LOOP
PEOCS NM
87552-1012
US

V. Phone/Fax

Practice location:
  • Phone: 505-757-2140
  • Fax:
Mailing address:
  • Phone: 505-757-2140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ELIZABETH TUTTLE
Title or Position: DOCTOR OF ORIENTAL MEDICINE
Credential: DOM
Phone: 505-757-2140