MEDICARE: MS. LINDA CLARKE 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	198.001460	IL

General Provider Information

NPI Number	:	1609338607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA CLARKE LAC

Provider Business Mailing Address
First Line	:	1442 CLEVELAND AVE
Second Line	:
City	:	LA GRANGE PARK
State	:	IL
Zip	:	60526-1306
Country	:	US
Telephone Number	:	708-408-5020
Fax Number	:

Provider Business Practice Location Address
First Line	:	1442 CLEVELAND AVE
Second Line	:
City	:	LA GRANGE PARK
State	:	IL
Zip	:	60526-1306
Country	:	US
Telephone Number	:	708-408-5020
Fax Number	:

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

Provider Enumeration Date	:	04/01/2019
Last Update Date	:	04/01/2019

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