MEDICARE: LOREN STARKS 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	0914	AZ

General Provider Information

NPI Number	:	1548702202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOREN STARKS L.AC.

Provider Business Mailing Address
First Line	:	6161 E PIMA ST TUCSON AZ 85712
Second Line	:	APT 2074
City	:	TUCSON
State	:	AZ
Zip	:	85712
Country	:	US
Telephone Number	:	520-320-1953
Fax Number	:	520-795-3948

Provider Business Practice Location Address
First Line	:	2930 N COUNTRY CLUB RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-1912
Country	:	US
Telephone Number	:	520-320-1953
Fax Number	:	520-795-3948

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

Provider Enumeration Date	:	11/12/2016
Last Update Date	:	12/21/2017

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