Healthcare Provider Details

I. General information

NPI: 1891200135
Provider Name (Legal Business Name): HANDWERK ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2017
Last Update Date: 12/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 PACHECO ST STE C6
SANTA FE NM
87505-3985
US

IV. Provider business mailing address

PO BOX 32764
SANTA FE NM
87594-2764
US

V. Phone/Fax

Practice location:
  • Phone: 505-920-8977
  • Fax:
Mailing address:
  • Phone: 505-920-8977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberNM942
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOHN M HANDWERK
Title or Position: OWNER
Credential: DOM
Phone: 505-920-8977