MEDICARE: DR. JOHN JAMES MINCE-ENNIS D.O.M

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	809	NM

General Provider Information

NPI Number	:	1306859863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN JAMES MINCE-ENNIS D.O.M

Provider Business Mailing Address
First Line	:	PO BOX 4173
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-7173
Country	:	US
Telephone Number	:	505-429-8859
Fax Number	:	575-421-8852

Provider Business Practice Location Address
First Line	:	721 1/2 7TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4238
Country	:	US
Telephone Number	:	505-429-8859
Fax Number	:	575-421-8852

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	05/02/2018

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Directions to “ DR. JOHN JAMES MINCE-ENNIS D.O.M” Practice Location

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