Provider Demographics
NPI:1447804000
Name:LIU, CHENG (LAC)
Entity Type:Individual
Prefix:
First Name:CHENG
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 SW 35TH PL APT 1405
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-3277
Mailing Address - Country:US
Mailing Address - Phone:774-257-8308
Mailing Address - Fax:
Practice Address - Street 1:1882 HAMMONDS FORK RD
Practice Address - Street 2:
Practice Address - City:DISPUTANTA
Practice Address - State:KY
Practice Address - Zip Code:40456-7714
Practice Address - Country:US
Practice Address - Phone:774-257-8308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist