MEDICARE: JOHN GRANVILLE ELLIOTT 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	8009	CA

General Provider Information

NPI Number	:	1386778827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN GRANVILLE ELLIOTT L.AC.

Provider Business Mailing Address
First Line	:	3519 NATHAN DR
Second Line	:	UNIT A
City	:	ANDERSON
State	:	CA
Zip	:	96007-3031
Country	:	US
Telephone Number	:	858-752-2302
Fax Number	:	530-243-3029

Provider Business Practice Location Address
First Line	:	1316 COURT ST
Second Line	:	#4
City	:	REDDING
State	:	CA
Zip	:	96001-1635
Country	:	US
Telephone Number	:	530-243-5230
Fax Number	:	530-243-3029

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/08/2007

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