Provider Demographics
NPI:1598133407
Name:LIU, YI CHUAN (DAOM)
Entity Type:Individual
Prefix:
First Name:YI CHUAN
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6232 BANKERS RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53403-9747
Mailing Address - Country:US
Mailing Address - Phone:262-554-2010
Mailing Address - Fax:
Practice Address - Street 1:6232 BANKERS RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53403-9747
Practice Address - Country:US
Practice Address - Phone:262-554-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001117171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist