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General NPI Number Information
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NPI Number | 1700389632
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Entity Type | Organization
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Legal Business Name | LYCHEE ACUPUNCTURE CLINIC, INC
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Dates
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Enumeration Date | 03/16/2018
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Last Update Date | 03/16/2018
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Provider Practice Location Address
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Address Line | 155 E SILVER SPRING DR STE 208
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City | WHITEFISH BAY
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State | WI
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Zip | 53217-4704
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Country | US
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Telephone | 414-962-5577
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Fax |
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Provider Business Mailing Address
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Address Line | 4946 N WILDWOOD AVE
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City | WHITEFISH BAY
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State | WI
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Zip | 53217-6014
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Country | US
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Telephone | 414-962-5577
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LIZHI WEI
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Credential | L.AC., DIPL. AC.
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Telephone | 414-962-5577
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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 | 110-055
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License Number State | WI
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