Provider Demographics
NPI:1700277241
Name:CHEN, CHUN CHENG (L AC)
Entity Type:Individual
Prefix:
First Name:CHUN CHENG
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 JUNIPER TRL
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7161
Mailing Address - Country:US
Mailing Address - Phone:919-518-3008
Mailing Address - Fax:
Practice Address - Street 1:12414 ALDERBROOK DR
Practice Address - Street 2:SUITE 250
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2596
Practice Address - Country:US
Practice Address - Phone:512-835-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01497171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist