Provider Demographics
NPI:1699102467
Name:ENHANCED WELLNESS
Entity type:Organization
Organization Name:ENHANCED WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:JAY
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:505-323-8100
Mailing Address - Street 1:5200 EUBANK BLVD NE
Mailing Address - Street 2:SUITE C3
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111
Mailing Address - Country:US
Mailing Address - Phone:505-323-8100
Mailing Address - Fax:505-292-0555
Practice Address - Street 1:5200 EUBANK BLVD NE
Practice Address - Street 2:SUITE C3
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111
Practice Address - Country:US
Practice Address - Phone:505-323-8100
Practice Address - Fax:505-292-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM90-216171100000X, 208VP0000X
NM637RX2174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty