Provider Demographics
NPI:1013054428
Name:HUANG, LI (DC, DILP, AC)
Entity Type:Individual
Prefix:DR
First Name:LI
Middle Name:
Last Name:HUANG
Suffix:
Gender:M
Credentials:DC, DILP, AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 LEISURE LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-4125
Mailing Address - Country:US
Mailing Address - Phone:803-750-0040
Mailing Address - Fax:803-750-9626
Practice Address - Street 1:128 LEISURE LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-4125
Practice Address - Country:US
Practice Address - Phone:803-750-0040
Practice Address - Fax:803-750-9626
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCH1281111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1281Medicaid