MEDICARE: PATRICIA TRIMBLE 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	198.000179	IL

General Provider Information

NPI Number	:	1487077053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA TRIMBLE LAC.

Provider Business Mailing Address
First Line	:	4710 N VIRGINIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3708
Country	:	US
Telephone Number	:	773-306-6905
Fax Number	:

Provider Business Practice Location Address
First Line	:	2742 W MONTROSE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-1536
Country	:	US
Telephone Number	:	773-306-6905
Fax Number	:

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

Provider Enumeration Date	:	02/01/2014
Last Update Date	:	02/01/2014

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