MEDICARE: ACU CARE ACUPUNCTURE CLINIC, INC

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	AC00461	TX

General Provider Information

NPI Number	:	1215181581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACU CARE ACUPUNCTURE CLINIC, INC

Provider Business Mailing Address
First Line	:	6633 N MESA ST STE 507
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-4422
Country	:	US
Telephone Number	:	915-585-6222
Fax Number	:	915-585-6230

Provider Business Practice Location Address
First Line	:	6633 N MESA ST STE 507
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-4422
Country	:	US
Telephone Number	:	915-585-6222
Fax Number	:	915-585-6230

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KELLY WYLIE
Credential	:	D.O.M., L. AC,
Telephone Number	:	915-585-6222

Provider Enumeration Date	:	11/12/2008
Last Update Date	:	11/12/2008

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