MEDICARE: INDY ACUPUNCTURE & HEALTH SERVICES, INC.

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	171W00000X	Contractor
2	171100000X	Acupuncturist	84000075A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	84000075A	OTHER	IN	NCCAOM

General Provider Information

NPI Number	:	1689949158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDY ACUPUNCTURE & HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	6155 N COLLEGE AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-1957
Country	:	US
Telephone Number	:	317-255-3030
Fax Number	:	317-255-3035

Provider Business Practice Location Address
First Line	:	6155 N COLLEGE AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-1957
Country	:	US
Telephone Number	:	317-255-3030
Fax Number	:	317-255-3035

Authorized Official
Title or Position	:	LICENSED ACUPUNCTURIST/ PRESIDENT
Name	:	MISS ERICA J SIEGEL
Credential	:	L.AC.
Telephone Number	:	317-255-3030

Provider Enumeration Date	:	03/17/2012
Last Update Date	:	06/27/2014

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