Provider Demographics
NPI:1891247615
Name:NATURAL EARTH HEALING CENTER
Entity Type:Organization
Organization Name:NATURAL EARTH HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:719-623-5874
Mailing Address - Street 1:620 S CASCADE AVE
Mailing Address - Street 2:#130
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-4039
Mailing Address - Country:US
Mailing Address - Phone:719-632-5784
Mailing Address - Fax:
Practice Address - Street 1:620 S CASCADE AVE
Practice Address - Street 2:#130
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-4039
Practice Address - Country:US
Practice Address - Phone:719-632-5784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10787172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty