MEDICARE: LEAH SHADWICK 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	AC01379	TX

General Provider Information

NPI Number	:	1790026508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH SHADWICK L.AC.

Provider Business Mailing Address
First Line	:	4101 MEDICAL PKWY
Second Line	:	SUITE 204
City	:	AUSTIN
State	:	TX
Zip	:	78756-3734
Country	:	US
Telephone Number	:	512-761-6719
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 MEDICAL PKWY
Second Line	:	SUITE 204
City	:	AUSTIN
State	:	TX
Zip	:	78756-3734
Country	:	US
Telephone Number	:	512-761-6719
Fax Number	:

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

Provider Enumeration Date	:	03/05/2013
Last Update Date	:	03/05/2013

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Directions to “ LEAH SHADWICK L.AC.” Practice Location

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