MEDICARE: MEILING QIAN DN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01632650	OTHER	IL	BLUE SHIELD OF IL

General Provider Information

NPI Number	:	1003916933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEILING QIAN DN

Provider Business Mailing Address
First Line	:	1635 W 37TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-2113
Country	:	US
Telephone Number	:	312-791-0025
Fax Number	:	312-791-0033

Provider Business Practice Location Address
First Line	:	467 W 31ST ST # 469
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3135
Country	:	US
Telephone Number	:	312-791-0025
Fax Number	:	312-791-0033

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	07/08/2007

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Directions to “ MEILING QIAN DN” Practice Location

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