MEDICARE: BETHANY ANNE HAUCH LIC AC, DVM

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

General Provider Information

NPI Number	:	1912227844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY ANNE HAUCH LIC AC, DVM

Provider Business Mailing Address
First Line	:	1118 NORRIS ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-2030
Country	:	US
Telephone Number	:	919-274-9028
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 HARGROVE RD
Second Line	:	SUITE 100
City	:	RALEIGH
State	:	NC
Zip	:	27616-1945
Country	:	US
Telephone Number	:	919-636-2148
Fax Number	:

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

Provider Enumeration Date	:	06/02/2010
Last Update Date	:	03/22/2016

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