MEDICARE: THIERA SMITH 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	198.001358	IL

General Provider Information

NPI Number	:	1558831081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THIERA SMITH LAC

Provider Business Mailing Address
First Line	:	2128 N MAPLEWOOD AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4116
Country	:	US
Telephone Number	:	773-988-7370
Fax Number	:

Provider Business Practice Location Address
First Line	:	2128 N MAPLEWOOD AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4116
Country	:	US
Telephone Number	:	773-988-7370
Fax Number	:

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

Provider Enumeration Date	:	11/27/2018
Last Update Date	:	11/27/2018

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Directions to “ THIERA SMITH LAC” Practice Location

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