MEDICARE: JOHN NIETERS, 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	AC6599	CA

General Provider Information

NPI Number	:	1720321128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN NIETERS, L.AC.

Provider Business Mailing Address
First Line	:	2258 SANTA CLARA AVE STE 1
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-4473
Country	:	US
Telephone Number	:	510-814-6900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2258 SANTA CLARA AVE STE 1
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-4473
Country	:	US
Telephone Number	:	510-814-6900
Fax Number	:

Authorized Official
Title or Position	:	LICENSED ACUPUNCTURIST
Name	:	DR. JOHN NIETERS
Credential	:	L.AC., DAOM
Telephone Number	:	51081409100

Provider Enumeration Date	:	04/03/2013
Last Update Date	:	04/03/2013

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