Provider Demographics
NPI:1134181977
Name:LI, TIEJUN (LAC, CMT)
Entity type:Individual
Prefix:
First Name:TIEJUN
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:LAC, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7422 SINGING HILLS DR
Mailing Address - Street 2:UNIT-K
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3768
Mailing Address - Country:US
Mailing Address - Phone:720-232-7688
Mailing Address - Fax:
Practice Address - Street 1:6620 GUNPARK DR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3339
Practice Address - Country:US
Practice Address - Phone:303-581-9955
Practice Address - Fax:303-581-9944
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO936171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist