Provider Demographics
NPI:1417384785
Name:MARY ZHANG CHINESE MEDICINE CLINIC, INC
Entity Type:Organization
Organization Name:MARY ZHANG CHINESE MEDICINE CLINIC, INC
Other - Org Name:CHINESE MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIMEI
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHANG
Authorized Official - Suffix:
Authorized Official - Credentials:LIC AC
Authorized Official - Phone:816-361-8885
Mailing Address - Street 1:9229 WARD PKWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114
Mailing Address - Country:US
Mailing Address - Phone:816-361-8885
Mailing Address - Fax:816-523-3555
Practice Address - Street 1:9229 WARD PKWY
Practice Address - Street 2:SUITE 107
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-3326
Practice Address - Country:US
Practice Address - Phone:816-361-8885
Practice Address - Fax:816-523-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012032696111N00000X
MO2005034880171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2005034880OtherMO ACUPUNCTURIST