Provider Demographics
NPI:1629528112
Name:YI, XUAN (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:XUAN
Middle Name:
Last Name:YI
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15112 PRIDE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4934
Mailing Address - Country:US
Mailing Address - Phone:501-312-9888
Mailing Address - Fax:
Practice Address - Street 1:15112 PRIDE VALLEY RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-4934
Practice Address - Country:US
Practice Address - Phone:501-312-9888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33715111N00000X
CA17810171100000X
AR076171100000X
AR16183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist