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General NPI Number Information
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NPI Number | 1225785215
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Entity Type | Individual
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Provider Name | JUN XU DOM, LAC
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Gender | Female
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Dates
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Enumeration Date | 03/09/2022
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 450 S STATE ROAD 135 STE B
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City | GREENWOOD
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State | IN
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Zip | 46142-1454
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Country | US
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Telephone | 317-889-8998
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Fax |
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Provider Business Mailing Address
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Address Line | 14479 BROOK MEADOW DR
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City | MCCORDSVILLE
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State | IN
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Zip | 46055-8815
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Country | US
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Telephone | 248-918-8824
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 84000152A
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License Number State | IN
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