MEDICARE: INTEGRATIVE ORIENTAL MEDICINE LLC

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	AP1583	FL

General Provider Information

NPI Number	:	1538508759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATIVE ORIENTAL MEDICINE LLC

Provider Business Mailing Address
First Line	:	5560A N OCEAN BLVD
Second Line	:
City	:	OCEAN RIDGE
State	:	FL
Zip	:	33435-7038
Country	:	US
Telephone Number	:	561-889-6662
Fax Number	:

Provider Business Practice Location Address
First Line	:	2247 PALM BEACH LAKES BLVD
Second Line	:	SUITE 204B
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-3470
Country	:	US
Telephone Number	:	561-889-6662
Fax Number	:

Authorized Official
Title or Position	:	ACUPUNCTURE PHYSICIAN
Name	:	DANIEL ROGER LEWIS
Credential	:
Telephone Number	:	561-889-6662

Provider Enumeration Date	:	06/20/2013
Last Update Date	:	06/20/2013

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