Healthcare Provider Details

I. General information

NPI: 1699938670
Provider Name (Legal Business Name): BO ZHUANG ACUPUNCTURIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N ALPINE RD 101
ROCKFORD IL
61107-4901
US

IV. Provider business mailing address

860 FALCON POINT PL
ROCKTON IL
61072-3302
US

V. Phone/Fax

Practice location:
  • Phone: 779-423-1700
  • Fax:
Mailing address:
  • Phone: 815-608-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198000709
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198.000709
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: