MEDICARE: LISA K LEDBETTER 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	597	CO

General Provider Information

NPI Number	:	1225179591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA K LEDBETTER L.AC.

Provider Business Mailing Address
First Line	:	5586 S SIMMS WAY
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80127-4557
Country	:	US
Telephone Number	:	303-979-1716
Fax Number	:

Provider Business Practice Location Address
First Line	:	3190 S WADSWORTH BLVD # 301
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-4899
Country	:	US
Telephone Number	:	303-934-3753
Fax Number	:	303-985-4673

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	07/08/2007

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