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General NPI Number Information
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NPI Number | 1770812158
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Entity Type | Organization
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Legal Business Name | SANTA FE BLISS, LLC
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Dates
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Enumeration Date | 12/15/2009
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Last Update Date | 12/16/2009
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Provider Practice Location Address
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Address Line | 301 E PALACE AVE SUITE C
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City | SANTA FE
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State | NM
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Zip | 87501-2221
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Country | US
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Telephone | 505-820-1572
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Fax |
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Provider Business Mailing Address
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Address Line | 301 E PALACE AVE SUITE C
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City | SANTA FE
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State | NM
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Zip | 87501-2221
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Country | US
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Telephone | 505-820-1572
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. WYATT WEGRZYN
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Credential |
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Telephone | 505-820-1572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1528
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 3377
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 938
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License Number State | NM
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