MEDICARE: MRS. JIA XU L.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		IL

General Provider Information

NPI Number	:	1447468202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JIA XU L.AC.

Provider Business Mailing Address
First Line	:	826 W 33RD PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-6702
Country	:	US
Telephone Number	:	773-890-1939
Fax Number	:

Provider Business Practice Location Address
First Line	:	2764 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1321
Country	:	US
Telephone Number	:	773-936-4325
Fax Number	:

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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