MEDICARE: MS. NANCY SUE THAL DIPL. AC., 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	553	CO

General Provider Information

NPI Number	:	1851354054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY SUE THAL DIPL. AC., L.AC.

Provider Business Mailing Address
First Line	:	553 GARFIELD AVE
Second Line	:
City	:	CARBONDALE
State	:	CO
Zip	:	81623-2052
Country	:	US
Telephone Number	:	970-963-6702
Fax Number	:

Provider Business Practice Location Address
First Line	:	553 GARFIELD AVE
Second Line	:
City	:	CARBONDALE
State	:	CO
Zip	:	81623-2052
Country	:	US
Telephone Number	:	970-963-6702
Fax Number	:

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	07/08/2007

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