=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659692978
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUL ACUPUNCTURE CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2010
-----------------------------------------------------
Last Update Date | 06/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 UNSER BLVD SE SUITE A
-----------------------------------------------------
City | RIO RANCHO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87124-6300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-892-7666
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 UNSER BLVD SE SUITE A
-----------------------------------------------------
City | RIO RANCHO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87124-6300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-892-7666
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF ORIENTAL MEDICINE
-----------------------------------------------------
Name | DR. DAVID SOUL
-----------------------------------------------------
Credential | D.O.M.
-----------------------------------------------------
Telephone | 505-506-2431
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 1027
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------