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General NPI Number Information
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NPI Number | 1932593696
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Entity Type | Organization
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Legal Business Name | CHARLES L. JAHTLOHEE ROGERS ANIKUTANI HEAD PRIEST
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Dates
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Enumeration Date | 03/20/2015
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Last Update Date | 03/23/2015
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Provider Practice Location Address
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Address Line | 9250 MCGREGOR LN
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City | DRIPPING SPRINGS
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State | TX
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Zip | 78620-3505
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Country | US
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Telephone | 512-858-2951
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Fax |
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Provider Business Mailing Address
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Address Line | 9250 MC GREGOR LANE
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City | DRIPPING SPRINGS
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State | TX
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Zip | 78620
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Country | US
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Telephone | 512-858-2951
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Fax |
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Authorized Official
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Title or Position | CHIEF PRIEST
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Name | CHARLES L. ROGERS
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Credential | M.D.
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Telephone | 512-858-2951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State | ZZ
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Taxonomy #2
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Taxonomy Code | 282J00000X
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Taxonomy Name | Religious Nonmedical Health Care Institution
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License Number |
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License Number State |
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