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General NPI Number Information
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NPI Number | 1457708604
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Entity Type | Organization
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Legal Business Name | PAUL JENKS, DOM, LLC
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 05/18/2016
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Provider Practice Location Address
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Address Line | 4010 CARLISLE BLVD NE SUITE B
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-4532
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Country | US
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Telephone | 505-872-2964
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Fax | 505-884-4958
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Provider Business Mailing Address
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Address Line | 4010 CARLISLE BLVD NE SUITE B
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-4532
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Country | US
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Telephone | 505-872-2964
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF ORIENTAL MEDICINE
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Name | DR. PAUL JENKS
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Credential | D.O.M.
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Telephone | 505-573-4652
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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 | 760
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License Number State | NM
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