Provider Demographics
NPI:1851588685
Name:FOUR WINDS ACUPUNCTURE
Entity Type:Organization
Organization Name:FOUR WINDS ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR ORIENTAL MEDICINE/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALES
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:505-470-5705
Mailing Address - Street 1:1660 OLD PECOS TRL
Mailing Address - Street 2:SUITE H
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4779
Mailing Address - Country:US
Mailing Address - Phone:505-470-5705
Mailing Address - Fax:
Practice Address - Street 1:1660 OLD PECOS TRL
Practice Address - Street 2:SUITE H
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4779
Practice Address - Country:US
Practice Address - Phone:505-470-5705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM926171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty