MEDICARE: MISS STEPHANIE KING LAC

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	ACU.0002631	CO

General Provider Information

NPI Number	:	1053988113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS STEPHANIE KING LAC

Provider Business Mailing Address
First Line	:	2526 1/2 N WEBER ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-6951
Country	:	US
Telephone Number	:	719-520-5056
Fax Number	:

Provider Business Practice Location Address
First Line	:	1422 N HANCOCK AVE STE 5
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-2641
Country	:	US
Telephone Number	:	719-520-5056
Fax Number	:

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

Provider Enumeration Date	:	06/08/2021
Last Update Date	:	06/08/2021

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Directions to “ MISS STEPHANIE KING LAC” Practice Location

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