MEDICARE: BRAD ELLIS THOMPSON LA.C, LMP

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	AC2654	WA

General Provider Information

NPI Number	:	1922253012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRAD ELLIS THOMPSON LA.C, LMP

Provider Business Mailing Address
First Line	:	601 UNION ST
Second Line	:	FLOOR 42
City	:	SEATTLE
State	:	WA
Zip	:	98101-2341
Country	:	US
Telephone Number	:	206-652-3233
Fax Number	:	206-652-3205

Provider Business Practice Location Address
First Line	:	601 UNION ST
Second Line	:	FLOOR 42
City	:	SEATTLE
State	:	WA
Zip	:	98101-2341
Country	:	US
Telephone Number	:	206-652-3233
Fax Number	:	206-652-3205

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

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	11/18/2008

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