MEDICARE: MR. MICHAEL FARRELL MS, 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	AC 13387	CA

General Provider Information

NPI Number	:	1558690081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL FARRELL MS, LAC

Provider Business Mailing Address
First Line	:	2828 AVENEL ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-2071
Country	:	US
Telephone Number	:	323-605-9343
Fax Number	:

Provider Business Practice Location Address
First Line	:	2828 AVENEL ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-2071
Country	:	US
Telephone Number	:	323-605-9343
Fax Number	:

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

Provider Enumeration Date	:	12/11/2009
Last Update Date	:	12/11/2009

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