MEDICARE: MICAH JOHN WILLIAMS 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	AC 13174	CA

General Provider Information

NPI Number	:	1649507211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICAH JOHN WILLIAMS L.AC

Provider Business Mailing Address
First Line	:	1869 SILVANA LN
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-3060
Country	:	US
Telephone Number	:	831-535-3080
Fax Number	:

Provider Business Practice Location Address
First Line	:	1869 SILVANA LN
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-3060
Country	:	US
Telephone Number	:	831-535-3080
Fax Number	:

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

Provider Enumeration Date	:	11/03/2009
Last Update Date	:	11/03/2009

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