Provider Demographics
NPI:1346585239
Name:AMERICAN CHINESE MEDICINE ASSOCIATION ACMA INC
Entity Type:Organization
Organization Name:AMERICAN CHINESE MEDICINE ASSOCIATION ACMA INC
Other - Org Name:AMERICAN CHINESE MEDICINE ASSOCIATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BO
Authorized Official - Middle Name:
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-685-6497
Mailing Address - Street 1:1307 BLUEJAY LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-5423
Mailing Address - Country:US
Mailing Address - Phone:815-685-6497
Mailing Address - Fax:815-230-1851
Practice Address - Street 1:1307 BLUEJAY LN
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-5423
Practice Address - Country:US
Practice Address - Phone:815-685-6497
Practice Address - Fax:815-230-1851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2013-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL099-0001 2 001133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty