MEDICARE: MR. WILLIAM XAVIER STAUB 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	ACU-748	HI

General Provider Information

NPI Number	:	1588675508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM XAVIER STAUB LAC

Provider Business Mailing Address
First Line	:	84-256 MAKAHA VALLEY RD
Second Line	:
City	:	WAIANAE
State	:	HI
Zip	:	96792-2129
Country	:	US
Telephone Number	:	808-695-9520
Fax Number	:

Provider Business Practice Location Address
First Line	:	84-256 MAKAHA VALLEY RD
Second Line	:
City	:	WAIANAE
State	:	HI
Zip	:	96792-2129
Country	:	US
Telephone Number	:	808-695-9520
Fax Number	:

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/08/2007

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