MEDICARE: MR. DAVE JAY COYNE L.AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	65.000205	OH
2	171100000X	Acupuncturist	TAC56	KY

General Provider Information

NPI Number	:	1033481379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVE JAY COYNE L.AC.

Provider Business Mailing Address
First Line	:	401 SHELDON AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207-1257
Country	:	US
Telephone Number	:	619-723-1540
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 S 1ST ST
Second Line	:	102
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-5404
Country	:	US
Telephone Number	:	619-723-1540
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2012
Last Update Date	:	02/02/2012

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