MEDICARE: DR. AMY LARUE DACM, 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	2023005790	MO

General Provider Information

NPI Number	:	1457124448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY LARUE DACM, LAC

Provider Business Mailing Address
First Line	:	5223 MARDEL AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-1760
Country	:	US
Telephone Number	:	314-368-0737
Fax Number	:

Provider Business Practice Location Address
First Line	:	8748 BIG BEND BLVD
Second Line	:
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-3730
Country	:	US
Telephone Number	:	314-918-1555
Fax Number	:

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

Provider Enumeration Date	:	11/01/2023
Last Update Date	:	11/01/2023

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