MEDICARE: NATURAL EARTH HEALING CENTER

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	172M00000X	Mechanotherapist	10787	CO

General Provider Information

NPI Number	:	1891247615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATURAL EARTH HEALING CENTER

Provider Business Mailing Address
First Line	:	620 S CASCADE AVE
Second Line	:	#130
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-4039
Country	:	US
Telephone Number	:	719-632-5784
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 S CASCADE AVE
Second Line	:	#130
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-4039
Country	:	US
Telephone Number	:	719-632-5784
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	MRS. MARY JO NICHOLS
Credential	:	LMT
Telephone Number	:	719-623-5874

Provider Enumeration Date	:	10/27/2016
Last Update Date	:	10/27/2016

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Directions to “NATURAL EARTH HEALING CENTER ” Practice Location

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