MEDICARE: SHIQIANG SU PH.D., LIC.AC.

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	171100000X	Acupuncturist	AC00446	TX

General Provider Information

NPI Number	:	1023190725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIQIANG SU PH.D., LIC.AC.

Provider Business Mailing Address
First Line	:	4207 JAMES CASEY ST STE 115
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-3362
Country	:	US
Telephone Number	:	512-383-1881
Fax Number	:

Provider Business Practice Location Address
First Line	:	4207 JAMES CASEY ST STE 115
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-3362
Country	:	US
Telephone Number	:	512-383-1881
Fax Number	:

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	09/05/2007

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