MEDICARE: KRISTIN ELIZABETH SUNDBERG L.AC., MAOM

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	AC01143	TX

General Provider Information

NPI Number	:	1215327929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN ELIZABETH SUNDBERG L.AC., MAOM

Provider Business Mailing Address
First Line	:	6503B CANNONLEAGUE DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-4917
Country	:	US
Telephone Number	:	512-632-4973
Fax Number	:	512-233-0744

Provider Business Practice Location Address
First Line	:	1609 NUECES ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-1105
Country	:	US
Telephone Number	:	512-632-4973
Fax Number	:	512-233-0744

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

Provider Enumeration Date	:	02/02/2015
Last Update Date	:	02/23/2015

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