Provider Demographics
NPI:1265025613
Name:DE'MEDICI CLASSICAL ACUPUNCTURE
Entity Type:Organization
Organization Name:DE'MEDICI CLASSICAL ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:K
Authorized Official - Last Name:DE'MEDICI
Authorized Official - Suffix:
Authorized Official - Credentials:RN/BSN LAC; DOM (NM
Authorized Official - Phone:505-516-2625
Mailing Address - Street 1:PO BOX 1091
Mailing Address - Street 2:
Mailing Address - City:FLORA VISTA
Mailing Address - State:NM
Mailing Address - Zip Code:87415-1091
Mailing Address - Country:US
Mailing Address - Phone:505-516-2625
Mailing Address - Fax:
Practice Address - Street 1:2243 MAIN AVE UNIT 19
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4655
Practice Address - Country:US
Practice Address - Phone:970-844-0408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty