MEDICARE: MICHELLE THORESON 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	00000101	WA

General Provider Information

NPI Number	:	1144357625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE THORESON L.AC

Provider Business Mailing Address
First Line	:	3019 NW 57TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-2552
Country	:	US
Telephone Number	:	206-781-1690
Fax Number	:

Provider Business Practice Location Address
First Line	:	2208 NW MARKET ST STE 409
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-4097
Country	:	US
Telephone Number	:	206-781-2734
Fax Number	:

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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