Healthcare Provider Details

I. General information

NPI: 1790017333
Provider Name (Legal Business Name): DONGXIAO LIU L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 W. LANCASTER AVE
ARDMORE PA
19003
US

IV. Provider business mailing address

2 W. LANCASTER AVE
ARDMORE PA
19003
US

V. Phone/Fax

Practice location:
  • Phone: 610-642-8888
  • Fax:
Mailing address:
  • Phone: 610-642-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberOM000049
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: