MEDICARE: KAITLAN DOWNES 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	84000166A	IN

General Provider Information

NPI Number	:	1740737188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLAN DOWNES L.AC

Provider Business Mailing Address
First Line	:	1315 W 86TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-2199
Country	:	US
Telephone Number	:	317-220-6600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1315 W 86TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-2199
Country	:	US
Telephone Number	:	317-220-6600
Fax Number	:

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

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	09/02/2016

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