MEDICARE: TINA CARLTON 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	198000558	IL

General Provider Information

NPI Number	:	1841684123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA CARLTON L.AC.

Provider Business Mailing Address
First Line	:	2138 W MCLEAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4525
Country	:	US
Telephone Number	:	773-317-9122
Fax Number	:

Provider Business Practice Location Address
First Line	:	6416 W HIGGINS AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60656-2203
Country	:	US
Telephone Number	:	773-774-6771
Fax Number	:

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

Provider Enumeration Date	:	03/24/2015
Last Update Date	:	03/24/2015

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