Provider Demographics
NPI:1861597809
Name:AI, SHAOFEN (DC LAC)
Entity type:Individual
Prefix:DR
First Name:SHAOFEN
Middle Name:
Last Name:AI
Suffix:
Gender:F
Credentials:DC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E NORTHWEST HWY
Mailing Address - Street 2:SUITE 15B
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067
Mailing Address - Country:US
Mailing Address - Phone:847-358-0890
Mailing Address - Fax:847-358-6390
Practice Address - Street 1:15 E NORTHWEST HWY
Practice Address - Street 2:SUITE 15B
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067
Practice Address - Country:US
Practice Address - Phone:847-358-0890
Practice Address - Fax:847-358-6390
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006750111N00000X
IL198000251171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1627886OtherBCBS
U43841Medicare UPIN
IL1627886OtherBCBS