Provider Demographics
NPI:1659603660
Name:CHANG, JAY XUE
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:XUE
Last Name:CHANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JIAN
Other - Middle Name:XUE
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NCCAOM CERTIFIED, LI
Mailing Address - Street 1:6501 N. SHERIDAN RD.
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614
Mailing Address - Country:US
Mailing Address - Phone:309-692-8110
Mailing Address - Fax:309-692-8673
Practice Address - Street 1:6501 N. SHERIDAN RD.
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614
Practice Address - Country:US
Practice Address - Phone:309-692-8110
Practice Address - Fax:309-692-8673
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000627171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist