=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073635231
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TCM HEALTH CENTER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2007
-----------------------------------------------------
Last Update Date | 11/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3710 GRAND WAY
-----------------------------------------------------
City | ST LOUIS PARK
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55416-5198
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-746-7992
-----------------------------------------------------
Fax | 952-746-7966
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3710 GRAND WAY
-----------------------------------------------------
City | ST LOUIS PARK
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55416-5198
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-746-7992
-----------------------------------------------------
Fax | 952-746-7966
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINIC DIRECTOR
-----------------------------------------------------
Name | MS. WEI LIU
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 952-746-7992
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 1017
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------