Provider Demographics
NPI:1073687026
Name:SHU, VICTOR (DC)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:SHU
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 1:151 87TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-1696
Mailing Address - Country:US
Mailing Address - Phone:650-757-7777
Mailing Address - Fax:650-757-3336
Practice Address - Street 1:151 87TH ST STE 4
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1696
Practice Address - Country:US
Practice Address - Phone:650-757-7777
Practice Address - Fax:650-757-3336
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29005111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0290050Medicare ID - Type Unspecified