MEDICARE: PHILIP CUSICK 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	7001	CA

General Provider Information

NPI Number	:	1093809626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP CUSICK L.AC.

Provider Business Mailing Address
First Line	:	310 EUREKA SQ
Second Line	:
City	:	PACIFICA
State	:	CA
Zip	:	94044-2652
Country	:	US
Telephone Number	:	650-359-6046
Fax Number	:	415-962-0605

Provider Business Practice Location Address
First Line	:	310 EUREKA SQ
Second Line	:
City	:	PACIFICA
State	:	CA
Zip	:	94044-2652
Country	:	US
Telephone Number	:	650-350-6046
Fax Number	:	415-962-0605

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	04/27/2010

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Directions to “ PHILIP CUSICK L.AC.” Practice Location

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