MEDICARE: DOUGLAS D. EISENSTARK 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	5444	CA

General Provider Information

NPI Number	:	1215994496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS D. EISENSTARK L.AC.

Provider Business Mailing Address
First Line	:	11275 1/2 WASHINGTON PL
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-4623
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11275 1/2 WASHINGTON PL
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-4623
Country	:	US
Telephone Number	:	310-403-7018
Fax Number	:

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

Provider Enumeration Date	:	04/29/2006
Last Update Date	:	07/08/2007

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Directions to “ DOUGLAS D. EISENSTARK L.AC.” Practice Location

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