Provider Demographics
NPI:1659692978
Name:SOUL ACUPUNCTURE CLINIC
Entity Type:Organization
Organization Name:SOUL ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF ORIENTAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUL
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:505-506-2431
Mailing Address - Street 1:12 UNSER BLVD SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-6300
Mailing Address - Country:US
Mailing Address - Phone:505-892-7666
Mailing Address - Fax:
Practice Address - Street 1:12 UNSER BLVD SE
Practice Address - Street 2:SUITE A
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-6300
Practice Address - Country:US
Practice Address - Phone:505-892-7666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1027171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty