Healthcare Provider Details

I. General information

NPI: 1134935810
Provider Name (Legal Business Name): GAN LIU DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3499 DULUTH PARK LN STE 110
DULUTH GA
30096-5716
US

IV. Provider business mailing address

49 HOPELAND DR
SAVANNAH GA
31419-2018
US

V. Phone/Fax

Practice location:
  • Phone: 770-623-9291
  • Fax: 770-623-1308
Mailing address:
  • Phone: 651-354-2382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR011282
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: