Provider Demographics
NPI:1629220769
Name:XU CLINIC ACUPUNCTURE & HERBAL PHARMACY, P.C.
Entity Type:Organization
Organization Name:XU CLINIC ACUPUNCTURE & HERBAL PHARMACY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ENDONG
Authorized Official - Middle Name:
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:ACUPUNCTURIST
Authorized Official - Phone:901-737-8282
Mailing Address - Street 1:256 GERMANTOWN BEND CV.
Mailing Address - Street 2:#102
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-5212
Mailing Address - Country:US
Mailing Address - Phone:901-737-8282
Mailing Address - Fax:901-737-8239
Practice Address - Street 1:256 GERMANTOWN BEND CV.
Practice Address - Street 2:#102
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-5212
Practice Address - Country:US
Practice Address - Phone:901-737-8282
Practice Address - Fax:901-737-8239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNACU0000000059171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12731OtherHERBOLOGY NCCAOM