MEDICARE: DR. KIMBALL BRADLEY CHATFIELD 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	2459	CA

General Provider Information

NPI Number	:	1427173442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBALL BRADLEY CHATFIELD L.AC.

Provider Business Mailing Address
First Line	:	2241 JAMES AVE
Second Line	:	SUITE 2
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-4348
Country	:	US
Telephone Number	:	530-541-1999
Fax Number	:

Provider Business Practice Location Address
First Line	:	2241 JAMES AVE
Second Line	:	SUITE 2
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-4348
Country	:	US
Telephone Number	:	530-541-1999
Fax Number	:

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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