Provider Demographics
NPI:1578966438
Name:SHEN DAO, LLC
Entity Type:Organization
Organization Name:SHEN DAO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:RA
Authorized Official - Phone:248-841-1570
Mailing Address - Street 1:126 E 3RD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6701
Mailing Address - Country:US
Mailing Address - Phone:248-841-1570
Mailing Address - Fax:
Practice Address - Street 1:126 E 3RD ST
Practice Address - Street 2:SUITE A
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-6701
Practice Address - Country:US
Practice Address - Phone:248-841-1570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5401000109171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty