MEDICARE: MEDICAL ACUPUNCTURE & PAIN CLINIC SC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033130927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL ACUPUNCTURE & PAIN CLINIC SC

Provider Business Mailing Address
First Line	:	422 MEADOWBROOK DR
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53090-2416
Country	:	US
Telephone Number	:	262-335-8025
Fax Number	:

Provider Business Practice Location Address
First Line	:	422 MEADOWBROOK DR
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53090-2416
Country	:	US
Telephone Number	:	262-335-8025
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	JESSE VEGAFRIA
Credential	:	MD
Telephone Number	:	262-335-8025

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	10/06/2011

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Directions to “MEDICAL ACUPUNCTURE & PAIN CLINIC SC ” Practice Location

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