Healthcare Provider Details

I. General information

NPI: 1538126529
Provider Name (Legal Business Name): FANGXI ZHOU L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1159 WILMETTE AVE SUITE 225
WILMETTE IL
60091-2649
US

IV. Provider business mailing address

1716 N CRILLY CT
CHICAGO IL
60614-5700
US

V. Phone/Fax

Practice location:
  • Phone: 847-337-5634
  • Fax:
Mailing address:
  • Phone: 312-988-9115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198000038
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: