Healthcare Provider Details

I. General information

NPI: 1326163619
Provider Name (Legal Business Name): LAN JIAN ZHAO NCCAOM-ACUPUNCTURE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4112 N PULASKI RD
CHICAGO IL
60641-2407
US

IV. Provider business mailing address

4112 N PULASKI RD
CHICAGO IL
60641-2407
US

V. Phone/Fax

Practice location:
  • Phone: 773-355-5052
  • Fax: 773-355-5052
Mailing address:
  • Phone: 773-355-5052
  • Fax: 773-355-5052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: