Healthcare Provider Details

I. General information

NPI: 1972623767
Provider Name (Legal Business Name): SHUNREN ZHU NCCAOM-ACUPUNCTURE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 CAROL ST # A
SKOKIE IL
60077-2235
US

IV. Provider business mailing address

4920 CAROL ST # A
SKOKIE IL
60077-2235
US

V. Phone/Fax

Practice location:
  • Phone: 847-675-1479
  • Fax: 847-675-1479
Mailing address:
  • Phone: 847-675-1479
  • Fax: 847-675-1479

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: