Healthcare Provider Details

I. General information

NPI: 1073704938
Provider Name (Legal Business Name): TRADITIONAL HEALING ARTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 BACA ST SUITE C
SANTA FE NM
87505-0972
US

IV. Provider business mailing address

914 BACA ST SUITE C
SANTA FE NM
87505-0972
US

V. Phone/Fax

Practice location:
  • Phone: 505-690-8855
  • Fax: 505-425-6040
Mailing address:
  • Phone: 505-690-8855
  • Fax: 505-425-6040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number661
License Number StateNM

VIII. Authorized Official

Name: DR. MARY K SPINDLER
Title or Position: DOM
Credential: PHD, DOM, LMT
Phone: 505-690-8855