Provider Demographics
NPI:1366597577
Name:CHINESE TRADITIONAL ACUPUNCTURE CLINIC,LLC
Entity type:Organization
Organization Name:CHINESE TRADITIONAL ACUPUNCTURE CLINIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZHAOPING
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-791-8628
Mailing Address - Street 1:1612 COMO AVE # B2
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-2718
Mailing Address - Country:US
Mailing Address - Phone:612-791-8628
Mailing Address - Fax:
Practice Address - Street 1:1612 COMO AVE # B2
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-2718
Practice Address - Country:US
Practice Address - Phone:612-791-8628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1016171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty