MEDICARE: MR. MICHAEL JOHN DEVONEY 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	WA00002207	WA

General Provider Information

NPI Number	:	1760770051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL JOHN DEVONEY LAC.

Provider Business Mailing Address
First Line	:	1012 W 15TH ST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98363-7232
Country	:	US
Telephone Number	:	360-808-5605
Fax Number	:

Provider Business Practice Location Address
First Line	:	1012 W 15TH ST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98363-7232
Country	:	US
Telephone Number	:	360-808-5605
Fax Number	:

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

Provider Enumeration Date	:	07/20/2011
Last Update Date	:	07/20/2011

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Directions to “ MR. MICHAEL JOHN DEVONEY LAC.” Practice Location

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