MEDICARE: MRS. LISA CAROLYN DUNLEVY M.AC, L.AC., DIPL. A

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		SC

General Provider Information

NPI Number	:	1104223973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA CAROLYN DUNLEVY M.AC, L.AC., DIPL. A

Provider Business Mailing Address
First Line	:	950 SEA GULL DR
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-4145
Country	:	US
Telephone Number	:	843-259-9889
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 SEA GULL DR
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-4145
Country	:	US
Telephone Number	:	843-259-9889
Fax Number	:

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

Provider Enumeration Date	:	11/22/2014
Last Update Date	:	11/22/2014

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