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General NPI Number Information
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NPI Number | 1295562155
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Entity Type | Organization
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Legal Business Name | AGAVE HEALING ARTS LLC
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Dates
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Enumeration Date | 09/16/2024
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 6657 STATE ROUTE 179 STE C1
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City | SEDONA
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State | AZ
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Zip | 86351-7000
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Country | US
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Telephone | 703-579-7606
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Fax |
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Provider Business Mailing Address
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Address Line | 256 PINON WOODS DR
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City | SEDONA
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State | AZ
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Zip | 86351-6902
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Country | US
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Telephone | 703-579-7606
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AIME L ADAMS
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Credential |
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Telephone | 703-579-7606
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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 |
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License Number State |
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