=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073704938
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRADITIONAL HEALING ARTS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2007
-----------------------------------------------------
Last Update Date | 01/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 914 BACA ST SUITE C
-----------------------------------------------------
City | SANTA FE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87505-0972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-690-8855
-----------------------------------------------------
Fax | 505-425-6040
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 914 BACA ST SUITE C
-----------------------------------------------------
City | SANTA FE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87505-0972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-690-8855
-----------------------------------------------------
Fax | 505-425-6040
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOM
-----------------------------------------------------
Name | DR. MARY K SPINDLER
-----------------------------------------------------
Credential | PHD, DOM, LMT
-----------------------------------------------------
Telephone | 505-690-8855
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 661
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------