Provider Demographics
NPI:1225785215
Name:XU, JUN (DOM, LAC)
Entity Type:Individual
Prefix:
First Name:JUN
Middle Name:
Last Name:XU
Suffix:
Gender:F
Credentials:DOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14479 BROOK MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:MCCORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055-8815
Mailing Address - Country:US
Mailing Address - Phone:248-918-8824
Mailing Address - Fax:
Practice Address - Street 1:450 S STATE ROAD 135 STE B
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1454
Practice Address - Country:US
Practice Address - Phone:317-889-8998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000152A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist