MEDICARE: JACQUELINE RENEE CLOSE MTCM, 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 00002019	WA

General Provider Information

NPI Number	:	1740329333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE RENEE CLOSE MTCM, L.AC.

Provider Business Mailing Address
First Line	:	7301 EARL AVE NW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98117-5942
Country	:	US
Telephone Number	:	206-650-1159
Fax Number	:

Provider Business Practice Location Address
First Line	:	2324 EASTLAKE AVE E
Second Line	:	SUITE 100
City	:	SEATTLE
State	:	WA
Zip	:	98102-3345
Country	:	US
Telephone Number	:	206-325-9297
Fax Number	:

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	07/08/2007

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