Provider Demographics
NPI:1780085589
Name:MIDWEST ALTERNATIVE MEDICINE CLINIC, LLC
Entity type:Organization
Organization Name:MIDWEST ALTERNATIVE MEDICINE CLINIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CHUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, PHD
Authorized Official - Phone:414-727-4640
Mailing Address - Street 1:4275 S 108TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-1907
Mailing Address - Country:US
Mailing Address - Phone:414-727-4640
Mailing Address - Fax:
Practice Address - Street 1:4275 S 108TH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-1907
Practice Address - Country:US
Practice Address - Phone:414-727-4640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty