MEDICARE: JOHN MA 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	AC00664	TX

General Provider Information

NPI Number	:	1619996287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN MA L.AC.

Provider Business Mailing Address
First Line	:	1321 E PIONEER PKWY
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-5868
Country	:	US
Telephone Number	:	817-265-8777
Fax Number	:	817-265-0802

Provider Business Practice Location Address
First Line	:	1321 E PIONEER PKWY
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-5868
Country	:	US
Telephone Number	:	817-265-8777
Fax Number	:	817-265-0802

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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