MEDICARE: MCIVER ACUPUNCTURE

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	251V00000X	Voluntary or Charitable Agency	004910	NY

General Provider Information

NPI Number	:	1124428941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCIVER ACUPUNCTURE

Provider Business Mailing Address
First Line	:	674 MOUL RD
Second Line	:
City	:	HILTON
State	:	NY
Zip	:	14468-9508
Country	:	US
Telephone Number	:	585-690-4224
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 LAKE AVE
Second Line	:
City	:	HILTON
State	:	NY
Zip	:	14468-1198
Country	:	US
Telephone Number	:	585-690-4224
Fax Number	:

Authorized Official
Title or Position	:	ACUPUNCTURIST
Name	:	MR. DOUGLAS STUART MCIVER
Credential	:	LAC
Telephone Number	:	585-690-4224

Provider Enumeration Date	:	08/28/2014
Last Update Date	:	08/28/2014

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