MEDICARE: MICHELLE TRUCKEY D.O.M, 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

General Provider Information

NPI Number	:	1356844328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE TRUCKEY D.O.M, L.AC.

Provider Business Mailing Address
First Line	:	1012 EUBANK BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-5310
Country	:	US
Telephone Number	:	505-298-4325
Fax Number	:

Provider Business Practice Location Address
First Line	:	1012 EUBANK BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-5310
Country	:	US
Telephone Number	:	505-298-4325
Fax Number	:	505-294-5407

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

Provider Enumeration Date	:	03/15/2018
Last Update Date	:	03/15/2018

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Directions to “ MICHELLE TRUCKEY D.O.M, L.AC.” Practice Location

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