Provider Demographics
NPI:1407144991
Name:FAN ACUPUNCTURE CLINIC, INC
Entity Type:Organization
Organization Name:FAN ACUPUNCTURE CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUNOU
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:720-244-3035
Mailing Address - Street 1:90 MADISON ST
Mailing Address - Street 2:STE 402
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5418
Mailing Address - Country:US
Mailing Address - Phone:720-244-3035
Mailing Address - Fax:720-941-2745
Practice Address - Street 1:90 MADISON ST
Practice Address - Street 2:STE 402
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5418
Practice Address - Country:US
Practice Address - Phone:720-244-3035
Practice Address - Fax:720-941-2745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty