Healthcare Provider Details

I. General information

NPI: 1548536931
Provider Name (Legal Business Name): DIWUCY LIU L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10124 MEDALLION DR
INDIANAPOLIS IN
46231-1923
US

IV. Provider business mailing address

10124 MEDALLION DR
INDIANAPOLIS IN
46231-1923
US

V. Phone/Fax

Practice location:
  • Phone: 317-445-7137
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number84000126A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: