MEDICARE: MR. GEORGE LECRENN 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	1101	TX

General Provider Information

NPI Number	:	1508005604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE LECRENN L.AC.

Provider Business Mailing Address
First Line	:	8016 LEVATA DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78739-1947
Country	:	US
Telephone Number	:	512-740-9501
Fax Number	:

Provider Business Practice Location Address
First Line	:	12016 W HWY 290 STE 4
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78737-2837
Country	:	US
Telephone Number	:	512-740-9501
Fax Number	:

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

Provider Enumeration Date	:	02/12/2009
Last Update Date	:	02/12/2009

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