MEDICARE: MIA PURIFICACION LAHOZ BS, MSAOM, 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	198.000861	IL

General Provider Information

NPI Number	:	1689941304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIA PURIFICACION LAHOZ BS, MSAOM, LAC

Provider Business Mailing Address
First Line	:	4214 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1202
Country	:	US
Telephone Number	:	773-749-0264
Fax Number	:

Provider Business Practice Location Address
First Line	:	2131 S ARCHER AVE # BANDC
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-1809
Country	:	US
Telephone Number	:	312-842-2775
Fax Number	:

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

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	11/23/2011

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