MEDICARE: SACRED FIELDS HEALING

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	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1720559719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRED FIELDS HEALING

Provider Business Mailing Address
First Line	:	26 GRAND AVE
Second Line	:
City	:	MANITOU SPRINGS
State	:	CO
Zip	:	80829-1726
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 GRAND AVE
Second Line	:
City	:	MANITOU SPRINGS
State	:	CO
Zip	:	80829-1726
Country	:	US
Telephone Number	:	719-360-7312
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FRANK S CHAVEZ
Credential	:	MASSAGE THERAPIST
Telephone Number	:	719-360-7312

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	12/17/2018

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Directions to “SACRED FIELDS HEALING ” Practice Location

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