MEDICARE: MICHELLE R THELEN 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	489	NC

General Provider Information

NPI Number	:	1558636498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE R THELEN L.AC.

Provider Business Mailing Address
First Line	:	1703 LEGION RD
Second Line	:	SUITE 206
City	:	CHAPEL HILL
State	:	NC
Zip	:	27517-2359
Country	:	US
Telephone Number	:	919-406-4858
Fax Number	:

Provider Business Practice Location Address
First Line	:	1703 LEGION RD
Second Line	:	SUITE 206
City	:	CHAPEL HILL
State	:	NC
Zip	:	27517-2359
Country	:	US
Telephone Number	:	919-406-4858
Fax Number	:

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

Provider Enumeration Date	:	03/10/2012
Last Update Date	:	03/10/2012

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