MEDICARE: LIGHTWORKS ACUPUNCTURE PLLC

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	305S00000X	Point of Service	0847	AZ

General Provider Information

NPI Number	:	1487906335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTWORKS ACUPUNCTURE PLLC

Provider Business Mailing Address
First Line	:	2362 S CAMINO SECO
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-7958
Country	:	US
Telephone Number	:	520-390-6767
Fax Number	:

Provider Business Practice Location Address
First Line	:	8120 E MOONSTONE DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85750-9647
Country	:	US
Telephone Number	:	520-390-6767
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CANDICE MOORE
Credential	:	L.AC.
Telephone Number	:	520-390-6767

Provider Enumeration Date	:	10/02/2012
Last Update Date	:	10/02/2012

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