Provider Demographics
NPI:1821221235
Name:SHEN, JING (LAC)
Entity Type:Individual
Prefix:
First Name:JING
Middle Name:
Last Name:SHEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1154 HOLLOW VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-2466
Mailing Address - Country:US
Mailing Address - Phone:636-536-4070
Mailing Address - Fax:636-489-1782
Practice Address - Street 1:17269 WILD HORSE CREEK RD
Practice Address - Street 2:SUITE 140
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1360
Practice Address - Country:US
Practice Address - Phone:636-536-4070
Practice Address - Fax:636-489-1782
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008011444171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist