MEDICARE: NEW TRADITIONS TCM HERBS & CLINIC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	350	NM

General Provider Information

NPI Number	:	1265739841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW TRADITIONS TCM HERBS & CLINIC, LLC

Provider Business Mailing Address
First Line	:	1925 JUAN TABO BLVD NE STE E
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-3359
Country	:	US
Telephone Number	:	505-291-8017
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 JUAN TABO BLVD NE STE E
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-3359
Country	:	US
Telephone Number	:	505-291-8017
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	GARY ALLEN
Credential	:	DOM
Telephone Number	:	505-291-8017

Provider Enumeration Date	:	02/17/2011
Last Update Date	:	02/17/2011

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