MEDICARE: JILLIAN ALSUP LAC.

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	AC01879	TX

General Provider Information

NPI Number	:	1114484045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN ALSUP LAC.

Provider Business Mailing Address
First Line	:	11421 HUNGRY HORSE DR
Second Line	:
City	:	MANOR
State	:	TX
Zip	:	78653-4657
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4131 SPICEWOOD SPRINGS RD STE I7
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8659
Country	:	US
Telephone Number	:	830-708-3610
Fax Number	:

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

Provider Enumeration Date	:	02/27/2019
Last Update Date	:	02/27/2019

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Directions to “ JILLIAN ALSUP LAC.” Practice Location

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