MEDICARE: MS. CAROLINE GRACE ASHURST L.AC., M.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	KO000642	PA

General Provider Information

NPI Number	:	1205268018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLINE GRACE ASHURST L.AC., M.AC.

Provider Business Mailing Address
First Line	:	4613 CEDAR AVE
Second Line	:	#3
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-2172
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 S 17TH ST
Second Line	:	#1502
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6231
Country	:	US
Telephone Number	:	215-429-2662
Fax Number	:

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

Provider Enumeration Date	:	08/02/2013
Last Update Date	:	08/02/2013

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