MEDICARE: SOUL ACUPUNCTURE CLINIC

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	1027	NM

General Provider Information

NPI Number	:	1659692978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUL ACUPUNCTURE CLINIC

Provider Business Mailing Address
First Line	:	12 UNSER BLVD SE
Second Line	:	SUITE A
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-6300
Country	:	US
Telephone Number	:	505-892-7666
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 UNSER BLVD SE
Second Line	:	SUITE A
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-6300
Country	:	US
Telephone Number	:	505-892-7666
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF ORIENTAL MEDICINE
Name	:	DR. DAVID SOUL
Credential	:	D.O.M.
Telephone Number	:	505-506-2431

Provider Enumeration Date	:	06/22/2010
Last Update Date	:	06/22/2010

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