MEDICARE: KAREN BOONE O.M.D., PH.D., 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	AC2672	CA
2	171100000X	Acupuncturist	441	CO

General Provider Information

NPI Number	:	1154519049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN BOONE O.M.D., PH.D., L.AC.

Provider Business Mailing Address
First Line	:	848 N RAINBOW BLVD # 843
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1103
Country	:	US
Telephone Number	:	206-888-2042
Fax Number	:	206-350-8665

Provider Business Practice Location Address
First Line	:	3960 HOWARD HUGHES PKWY STE 500
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-5988
Country	:	US
Telephone Number	:	206-888-0330
Fax Number	:

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

Provider Enumeration Date	:	10/04/2007
Last Update Date	:	02/20/2014

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