MEDICARE: MRS. BRONWYN DALTON CLARK L.AC., M.AC., DIPLAC

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	AC500090	DC

General Provider Information

NPI Number	:	1154513737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRONWYN DALTON CLARK L.AC., M.AC., DIPLAC

Provider Business Mailing Address
First Line	:	1932 35TH PLACE, NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20007
Country	:	US
Telephone Number	:	301-213-9117
Fax Number	:

Provider Business Practice Location Address
First Line	:	1740 WISCONSIN AVE NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20007-2313
Country	:	US
Telephone Number	:	202-321-2923
Fax Number	:

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

Provider Enumeration Date	:	08/16/2007
Last Update Date	:	08/04/2010

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Directions to “ MRS. BRONWYN DALTON CLARK L.AC., M.AC., DIPLAC” Practice Location

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