Healthcare Provider Details

I. General information

NPI: 1457481624
Provider Name (Legal Business Name): NA ZHAI PH.D., OMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 W WHITE OAKS DR
SPRINGFIELD IL
62704-7421
US

IV. Provider business mailing address

2309 W WHITE OAKS DR
SPRINGFIELD IL
62704-7421
US

V. Phone/Fax

Practice location:
  • Phone: 217-698-6259
  • Fax: 217-698-6265
Mailing address:
  • Phone: 217-698-6259
  • Fax: 217-698-6265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198-000171
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: