MEDICARE: DR. EDWARD SONG L.AC., PH.D.

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	AC00007

General Provider Information

NPI Number	:	1497187942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD SONG L.AC., PH.D.

Provider Business Mailing Address
First Line	:	2625 OLD DENTON RD
Second Line	:	SUITE 546
City	:	CARROLLTON
State	:	TX
Zip	:	75007-5125
Country	:	US
Telephone Number	:	972-608-8877
Fax Number	:	972-245-8888

Provider Business Practice Location Address
First Line	:	2625 OLD DENTON RD
Second Line	:	SUITE 546
City	:	CARROLLTON
State	:	TX
Zip	:	75007-5125
Country	:	US
Telephone Number	:	972-608-8877
Fax Number	:	972-245-8888

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

Provider Enumeration Date	:	08/07/2013
Last Update Date	:	08/07/2013

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