Provider Demographics
NPI:1891200135
Name:HANDWERK ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:HANDWERK ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HANDWERK
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:505-920-8977
Mailing Address - Street 1:PO BOX 32764
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87594-2764
Mailing Address - Country:US
Mailing Address - Phone:505-920-8977
Mailing Address - Fax:
Practice Address - Street 1:1570 PACHECO ST STE C6
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3985
Practice Address - Country:US
Practice Address - Phone:505-920-8977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM942171100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM942OtherSTATE ACUPUNCTURE LICENSE