Provider Demographics
NPI:1306171954
Name:QIU, ZHIJIA JACK (DC)
Entity type:Individual
Prefix:DR
First Name:ZHIJIA
Middle Name:JACK
Last Name:QIU
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 1:2440 HIGHWAY 95, SUITE A
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442
Mailing Address - Country:US
Mailing Address - Phone:928-704-2225
Mailing Address - Fax:928-704-0402
Practice Address - Street 1:2440 HIGHWAY 95, SUITE A
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442
Practice Address - Country:US
Practice Address - Phone:928-704-2225
Practice Address - Fax:928-704-0402
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011396111N00000X
AZ8188111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor