Provider Demographics
NPI:1376998518
Name:CHINN QIGONG & ACUPUNCTURE
Entity Type:Organization
Organization Name:CHINN QIGONG & ACUPUNCTURE
Other - Org Name:CHINN CHINESE MEDICINE & ACUPUNCTURE, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/OPERATOR & QIGONG HEALER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:CHINN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MSTCM, CMQ
Authorized Official - Phone:925-759-2319
Mailing Address - Street 1:130 LA CASA VIA STE 101
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3065
Mailing Address - Country:US
Mailing Address - Phone:925-759-2319
Mailing Address - Fax:925-687-1990
Practice Address - Street 1:130 LA CASA VIA STE 101
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3065
Practice Address - Country:US
Practice Address - Phone:925-759-2319
Practice Address - Fax:925-687-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13669171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty