MEDICARE: MS. TY M. MILLER 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	709	CO

General Provider Information

NPI Number	:	1427131184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TY M. MILLER L.AC.

Provider Business Mailing Address
First Line	:	4845 OLD POST CIR
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-3966
Country	:	US
Telephone Number	:	303-579-5799
Fax Number	:

Provider Business Practice Location Address
First Line	:	2769 IRIS AVE STE 109
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-4405
Country	:	US
Telephone Number	:	303-579-5799
Fax Number	:

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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