Healthcare Provider Details

I. General information

NPI: 1851588685
Provider Name (Legal Business Name): FOUR WINDS ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 OLD PECOS TRL SUITE H
SANTA FE NM
87505-4779
US

IV. Provider business mailing address

1660 OLD PECOS TRL SUITE H
SANTA FE NM
87505-4779
US

V. Phone/Fax

Practice location:
  • Phone: 505-470-5705
  • Fax:
Mailing address:
  • Phone: 505-470-5705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number926
License Number StateNM

VIII. Authorized Official

Name: DR. NATHAN WALES
Title or Position: DOCTOR ORIENTAL MEDICINE/OWNER
Credential: DOM
Phone: 505-470-5705