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General NPI Number Information
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NPI Number | 1124369830
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Entity Type | Organization
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Legal Business Name | MICHAEL'S ACUPUNTURE AND FITNESS
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 909 EARLY ST
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City | SANTA FE
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State | NM
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Zip | 87505-1637
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Country | US
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Telephone | 505-660-9058
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 32431
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City | SANTA FE
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State | NM
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Zip | 87594-2431
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Country | US
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Telephone | 505-660-9058
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Fax |
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Authorized Official
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Title or Position | DOCTOR OR ORIENTAL MEDICINE
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Name | MICHAEL HANER
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Credential | M.S.O.M.
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Telephone | 505-660-9058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 1006
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License Number State | NM
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