Provider Demographics
NPI:1700129483
Name:CHEN, HAICHEN (LAC)
Entity Type:Individual
Prefix:MS
First Name:HAICHEN
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:91 BEECH ST APT 41
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-2769
Mailing Address - Country:US
Mailing Address - Phone:512-698-7210
Mailing Address - Fax:
Practice Address - Street 1:545 KEARNY AVE
Practice Address - Street 2:SUITE2
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2759
Practice Address - Country:US
Practice Address - Phone:512-698-7210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01416171100000X
NJ25MZ00102200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist