Provider Demographics
NPI:1477017747
Name:BIOELECTRO MEDICINE LLC
Entity Type:Organization
Organization Name:BIOELECTRO MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:505-363-1428
Mailing Address - Street 1:14 FIR LOOP
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREST
Mailing Address - State:NM
Mailing Address - Zip Code:87008-9468
Mailing Address - Country:US
Mailing Address - Phone:505-506-1230
Mailing Address - Fax:505-212-1087
Practice Address - Street 1:14 FIR LOOP
Practice Address - Street 2:
Practice Address - City:CEDAR CREST
Practice Address - State:NM
Practice Address - Zip Code:87008-9468
Practice Address - Country:US
Practice Address - Phone:505-506-1230
Practice Address - Fax:505-212-1087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty