MEDICARE: SUSANNAH G NEAL LAC

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	552	CO

General Provider Information

NPI Number	:	1285855205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANNAH G NEAL LAC

Provider Business Mailing Address
First Line	:	4249 KINGSBURY DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525
Country	:	US
Telephone Number	:	970-377-2610
Fax Number	:

Provider Business Practice Location Address
First Line	:	4115 BOARDWALK DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525
Country	:	US
Telephone Number	:	970-226-0670
Fax Number	:

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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