Healthcare Provider Details

I. General information

NPI: 1902626724
Provider Name (Legal Business Name): ENCHANTMENT ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 HOMESTEADS RD STE F
PLACITAS NM
87043-9229
US

IV. Provider business mailing address

3 HOMESTEADS RD STE F
PLACITAS NM
87043-9229
US

V. Phone/Fax

Practice location:
  • Phone: 505-401-7738
  • Fax:
Mailing address:
  • Phone: 505-401-7738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JESSICA SCHULTE
Title or Position: DOCTOR OF ORIENTAL MEDICINE
Credential: MSOM, DOM
Phone: 505-401-7738