MEDICARE: CHARLES ROBERT MENDELSON 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	AC60556797	WA

General Provider Information

NPI Number	:	1316320823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES ROBERT MENDELSON LAC

Provider Business Mailing Address
First Line	:	1817 QUEEN ANNE AVE N STE 204
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-2876
Country	:	US
Telephone Number	:	206-679-2421
Fax Number	:

Provider Business Practice Location Address
First Line	:	3452 40TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-3420
Country	:	US
Telephone Number	:	206-437-8073
Fax Number	:

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

Provider Enumeration Date	:	07/01/2015
Last Update Date	:	07/01/2015

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