Basic Information
| Provider Information | |||||||||
| NPI: | 1437585221 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TREE OF LIFE INTEGRATIVE MEDICINE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 826 CAMINO DE MONTE REY STE A4 | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875053961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052314261 | ||||||||
| FaxNumber: | 5059866005 | ||||||||
| Practice Location | |||||||||
| Address1: | 826 CAMINO DE MONTE REY STE A4 | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875053961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052314261 | ||||||||
| FaxNumber: | 5059866005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2013 | ||||||||
| LastUpdateDate: | 09/25/2013 | ||||||||
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| AuthorizedOfficialLastName: | BRUNN | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
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| AuthorizedOfficialTitleorPosition: | DR OF ORIENTAL MEDICINE | ||||||||
| AuthorizedOfficialTelephone: | 5052314261 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O.M. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | 1085 | NM | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Acupuncturist |
No ID Information.