Provider Demographics
NPI:1225177876
Name:CHAU, MABEL MP (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:MABEL
Middle Name:MP
Last Name:CHAU
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 1:1415 E COLORADO ST STE 209
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1541
Mailing Address - Country:US
Mailing Address - Phone:818-956-5165
Mailing Address - Fax:
Practice Address - Street 1:1415 E COLORADO ST STE 209
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1541
Practice Address - Country:US
Practice Address - Phone:818-956-5165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12630111N00000X
CAAC14257171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC14257OtherACUPUNCTURE
CADC12630OtherCHIROPRACTIC