MEDICARE: MS. JILL ADRIAN TUCCI LAC

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	143	CO

General Provider Information

NPI Number	:	1205037082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JILL ADRIAN TUCCI LAC

Provider Business Mailing Address
First Line	:	3113 N PROSPECT ST
Second Line	:
City	:	COLO SPRINGS
State	:	CO
Zip	:	80907-5553
Country	:	US
Telephone Number	:	719-634-8706
Fax Number	:

Provider Business Practice Location Address
First Line	:	2924 BEACON ST
Second Line	:	SUITE A
City	:	COLO SPGS
State	:	CO
Zip	:	80907-5553
Country	:	US
Telephone Number	:	719-634-3010
Fax Number	:

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	07/08/2007

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