MEDICARE: JEFFREY GROSSMAN 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	401	WA

General Provider Information

NPI Number	:	1366596918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY GROSSMAN L.AC.

Provider Business Mailing Address
First Line	:	2033 10TH AVE E
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-4105
Country	:	US
Telephone Number	:	206-860-9090
Fax Number	:

Provider Business Practice Location Address
First Line	:	2033 10TH AVE E
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-4105
Country	:	US
Telephone Number	:	206-860-9090
Fax Number	:

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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Directions to “ JEFFREY GROSSMAN L.AC.” Practice Location

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