=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396132791
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALING JOURNEYS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2015
-----------------------------------------------------
Last Update Date | 04/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13825 N 7TH ST SUITE H
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85022-4342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-396-5574
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13825 N 7TH ST SUITE H
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85022-4342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-396-5574
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | CHARMAINE MARCK
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 623-396-5573
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 0841
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------