Healthcare Provider Details

I. General information

NPI: 1407251838
Provider Name (Legal Business Name): ACUPUNCTURE COLLECTIVELLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 N KENTUCKY ST
SILVER CITY NM
88061-3925
US

IV. Provider business mailing address

2024 HOPI RD
SANTA FE NM
87505-2402
US

V. Phone/Fax

Practice location:
  • Phone: 505-920-8339
  • Fax:
Mailing address:
  • Phone: 505-920-8339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number168
License Number StateNM

VIII. Authorized Official

Name: DR. KATHLEEN M. CAMPBELL
Title or Position: OWNER
Credential: DOM
Phone: 505-920-8339