MEDICARE: KEALA MEYER CHRISTECK

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	AC17905	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AC17905	OTHER	CA	ACUPUNCTURE

General Provider Information

NPI Number	:	1689185423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEALA MEYER CHRISTECK

Provider Business Mailing Address
First Line	:	2228 6TH ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94710-2219
Country	:	US
Telephone Number	:	510-540-6267
Fax Number	:	510-540-6212

Provider Business Practice Location Address
First Line	:	2228 6TH ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94710-2219
Country	:	US
Telephone Number	:	510-540-6267
Fax Number	:	510-540-6212

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

Provider Enumeration Date	:	10/19/2017
Last Update Date	:	06/16/2018

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