MEDICARE: CRESCENT CITY ACUPUNCTURE AND HERBAL MEDICINE, LLC

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	ACA200038	LA

General Provider Information

NPI Number	:	1417407610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRESCENT CITY ACUPUNCTURE AND HERBAL MEDICINE, LLC

Provider Business Mailing Address
First Line	:	4322 CANAL ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-5945
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4322 CANAL ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-5945
Country	:	US
Telephone Number	:	504-407-5909
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES A SMITH
Credential	:	LAC
Telephone Number	:	504-407-5909

Provider Enumeration Date	:	10/11/2016
Last Update Date	:	10/11/2016

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