Provider Demographics
NPI:1174068753
Name:SUN, CHUNCHIEH BRUCE (LAC, LMT)
Entity type:Individual
Prefix:
First Name:CHUNCHIEH
Middle Name:BRUCE
Last Name:SUN
Suffix:
Gender:M
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2762 GATEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-8310
Mailing Address - Country:US
Mailing Address - Phone:414-312-1777
Mailing Address - Fax:
Practice Address - Street 1:2762 GATEWAY AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-8310
Practice Address - Country:US
Practice Address - Phone:414-312-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI821-55171100000X
IL198.001288171100000X
WI2308-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist