Provider Demographics
NPI:1134935810
Name:LIU, GAN (DC)
Entity type:Individual
Prefix:
First Name:GAN
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 HOPELAND DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-2018
Mailing Address - Country:US
Mailing Address - Phone:651-354-2382
Mailing Address - Fax:
Practice Address - Street 1:3499 DULUTH PARK LN STE 110
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5716
Practice Address - Country:US
Practice Address - Phone:770-623-9291
Practice Address - Fax:770-623-1308
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR011282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor