Provider Demographics
NPI:1497591085
Name:JU, MICHELLE (LAC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:JU
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 1:817 REINERMAN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-5237
Mailing Address - Country:US
Mailing Address - Phone:832-541-1478
Mailing Address - Fax:
Practice Address - Street 1:2500 E T C JESTER BLVD STE 130
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1454
Practice Address - Country:US
Practice Address - Phone:713-338-9657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC02150171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist