MEDICARE: TUCKER R HOPP 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	AC60201869	WA

General Provider Information

NPI Number	:	1376848465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TUCKER R HOPP LAC

Provider Business Mailing Address
First Line	:	9574 LAKE SHORE BLVD NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-2644
Country	:	US
Telephone Number	:	206-940-2879
Fax Number	:

Provider Business Practice Location Address
First Line	:	9574 LAKE SHORE BLVD NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-2644
Country	:	US
Telephone Number	:	206-940-2879
Fax Number	:

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

Provider Enumeration Date	:	01/20/2011
Last Update Date	:	01/20/2011

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