Healthcare Provider Details

I. General information

NPI: 1437585221
Provider Name (Legal Business Name): TREE OF LIFE INTEGRATIVE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 CAMINO DE MONTE REY STE A4
SANTA FE NM
87505-3961
US

IV. Provider business mailing address

826 CAMINO DE MONTE REY STE A4
SANTA FE NM
87505-3961
US

V. Phone/Fax

Practice location:
  • Phone: 505-231-4261
  • Fax: 505-986-6005
Mailing address:
  • Phone: 505-231-4261
  • Fax: 505-986-6005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1085
License Number StateNM

VIII. Authorized Official

Name: ERIC BRUNN
Title or Position: DR OF ORIENTAL MEDICINE
Credential: D.O.M.
Phone: 505-231-4261