Provider Demographics
NPI:1962780221
Name:CHU, QIN (LAC)
Entity type:Individual
Prefix:MS
First Name:QIN
Middle Name:
Last Name:CHU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 MAXWELL DR.
Mailing Address - Street 2:SUITE D
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016
Mailing Address - Country:US
Mailing Address - Phone:715-808-0735
Mailing Address - Fax:715-808-8364
Practice Address - Street 1:1615 MAXWELL DR.
Practice Address - Street 2:SUITE D
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016
Practice Address - Country:US
Practice Address - Phone:715-808-0735
Practice Address - Fax:715-808-8364
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1563171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist