Provider Demographics
NPI:1063430601
Name:LIU, CHUAN (LAC, PHD)
Entity type:Individual
Prefix:MR
First Name:CHUAN
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:LAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4275 S 108TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-1907
Mailing Address - Country:US
Mailing Address - Phone:414-727-4640
Mailing Address - Fax:414-727-4636
Practice Address - Street 1:4275 S 108TH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-1907
Practice Address - Country:US
Practice Address - Phone:414-727-4640
Practice Address - Fax:414-727-4636
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist