Provider Demographics
NPI:1396837993
Name:LIU, JOSEPH (DC, QME)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:DC, QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 BETHARDS DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-8500
Mailing Address - Country:US
Mailing Address - Phone:707-576-7000
Mailing Address - Fax:707-576-0656
Practice Address - Street 1:2323 BETHARDS DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-8500
Practice Address - Country:US
Practice Address - Phone:707-576-7000
Practice Address - Fax:707-576-0656
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 25592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0255920Medicare ID - Type UnspecifiedMEDICARE
CAU84126Medicare UPIN