MEDICARE: KRISTIN GUNDRUM 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	AC044	KY
2	171100000X	Acupuncturist	65.000161	OH

General Provider Information

NPI Number	:	1487909420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN GUNDRUM L.AC.

Provider Business Mailing Address
First Line	:	7860 WOOSTER PIKE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45227-4002
Country	:	US
Telephone Number	:	513-370-4471
Fax Number	:

Provider Business Practice Location Address
First Line	:	1026 DELTA AVE STE A
Second Line	:	BLOOMING LOTUS ACUPUNCTURE
City	:	CINCINNATI
State	:	OH
Zip	:	45208-3164
Country	:	US
Telephone Number	:	513-400-4170
Fax Number	:

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

Provider Enumeration Date	:	07/16/2012
Last Update Date	:	04/10/2017

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