Provider Demographics
NPI:1144767021
Name:SHU CHIROPRACTIC AND ASSOCIATES CORPORATION
Entity Type:Organization
Organization Name:SHU CHIROPRACTIC AND ASSOCIATES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-509-6632
Mailing Address - Street 1:407 N SAN MATEO DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2417
Mailing Address - Country:US
Mailing Address - Phone:415-509-6632
Mailing Address - Fax:
Practice Address - Street 1:407 N SAN MATEO DR
Practice Address - Street 2:SUITE 5
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2417
Practice Address - Country:US
Practice Address - Phone:415-509-6632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29005261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center