Provider Demographics
NPI:1780190678
Name:QU, FENGXIA
Entity Type:Individual
Prefix:
First Name:FENGXIA
Middle Name:
Last Name:QU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7616 NE HAZEL DELL AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8224
Mailing Address - Country:US
Mailing Address - Phone:360-694-0400
Mailing Address - Fax:
Practice Address - Street 1:11215 NE 28TH ST STE 5
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-7805
Practice Address - Country:US
Practice Address - Phone:360-258-1470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60548334111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor