Provider Demographics
NPI:1306818398
Name:WU, WEN (DC , DOM)
Entity Type:Individual
Prefix:DR
First Name:WEN
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:DC , DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 WYOMING BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-4540
Mailing Address - Country:US
Mailing Address - Phone:505-294-5486
Mailing Address - Fax:505-294-3655
Practice Address - Street 1:2709 WYOMING BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-4540
Practice Address - Country:US
Practice Address - Phone:505-294-5486
Practice Address - Fax:505-294-3655
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1039111N00000X
NM061171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00R462OtherBCBSNM
NMNM00R462OtherBCBSNM