Provider Demographics
NPI:1598377392
Name:CHINESE MEDICINE DR LIU LLC
Entity Type:Organization
Organization Name:CHINESE MEDICINE DR LIU LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:LIBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-619-0439
Mailing Address - Street 1:1113 DICKENS AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-4302
Mailing Address - Country:US
Mailing Address - Phone:312-619-0439
Mailing Address - Fax:312-616-0439
Practice Address - Street 1:1113 DICKENS AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-4302
Practice Address - Country:US
Practice Address - Phone:312-619-0439
Practice Address - Fax:312-619-0439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL198001533Medicaid