MEDICARE: AVELIZA MERCADO 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	ACU112	TN

General Provider Information

NPI Number	:	1457673030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVELIZA MERCADO LAC

Provider Business Mailing Address
First Line	:	320 E MAIN ST STE 200
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37408-1609
Country	:	US
Telephone Number	:	423-643-2246
Fax Number	:	423-643-2030

Provider Business Practice Location Address
First Line	:	1100 E 3RD ST
Second Line	:	SUITE G-100
City	:	CHATTANOOGA
State	:	TN
Zip	:	37403-2241
Country	:	US
Telephone Number	:	423-643-2246
Fax Number	:	423-643-2030

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

Provider Enumeration Date	:	02/23/2010
Last Update Date	:	01/03/2019

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