MEDICARE: TAMRA S JORDAN L.AC., LMT

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	AC01383	TX

General Provider Information

NPI Number	:	1619300860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMRA S JORDAN L.AC., LMT

Provider Business Mailing Address
First Line	:	1235 CLEAR LAKE CITY BLVD
Second Line	:	SUITE F
City	:	HOUSTON
State	:	TX
Zip	:	77062-8124
Country	:	US
Telephone Number	:	281-928-4669
Fax Number	:

Provider Business Practice Location Address
First Line	:	1235 CLEAR LAKE CITY BLVD
Second Line	:	SUITE F
City	:	HOUSTON
State	:	TX
Zip	:	77062-8124
Country	:	US
Telephone Number	:	281-928-4669
Fax Number	:

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

Provider Enumeration Date	:	08/12/2013
Last Update Date	:	12/12/2016

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