MEDICARE: ACUPUNCTURE AND HERBAL MEDICINE LLC

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	AP1667	FL

General Provider Information

NPI Number	:	1992988083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACUPUNCTURE AND HERBAL MEDICINE LLC

Provider Business Mailing Address
First Line	:	122 FAULKNER ST
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7018
Country	:	US
Telephone Number	:	813-659-2502
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 FAULKNER ST
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7018
Country	:	US
Telephone Number	:	813-659-2502
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHARLOTTE HAAS
Credential	:	AP
Telephone Number	:	813-659-2502

Provider Enumeration Date	:	12/11/2007
Last Update Date	:	12/12/2007

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