MEDICARE: LARRY KULICK 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	AC00000518	WA

General Provider Information

NPI Number	:	1205046356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY KULICK L. AC

Provider Business Mailing Address
First Line	:	PO BOX 1071
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99210-1071
Country	:	US
Telephone Number	:	509-624-4937
Fax Number	:	509-456-3730

Provider Business Practice Location Address
First Line	:	3430 S GRAND BLVD
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99203-2621
Country	:	US
Telephone Number	:	509-624-4937
Fax Number	:	509-456-3730

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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