Provider Demographics
NPI:1033592001
Name:XIE, YI
Entity Type:Individual
Prefix:
First Name:YI
Middle Name:
Last Name:XIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22060 MADISON ST
Mailing Address - Street 2:APT302
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3664
Mailing Address - Country:US
Mailing Address - Phone:563-508-5737
Mailing Address - Fax:
Practice Address - Street 1:22615 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2115
Practice Address - Country:US
Practice Address - Phone:563-508-5737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012826111N00000X
MI2301010414111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor