Provider Demographics
NPI:1265500144
Name:DONG, XIAOLU JIA (DC)
Entity Type:Individual
Prefix:DR
First Name:XIAOLU
Middle Name:JIA
Last Name:DONG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 HWY 9 BYPASS EAST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720
Mailing Address - Country:US
Mailing Address - Phone:803-286-5700
Mailing Address - Fax:803-285-6119
Practice Address - Street 1:539 HWY 9 BYPASS EAST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720
Practice Address - Country:US
Practice Address - Phone:803-286-5700
Practice Address - Fax:803-285-6119
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1662111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1662Medicaid
SCCH1662Medicaid
SCU38407Medicare UPIN