Provider Demographics
NPI:1467040139
Name:SIU, TOMMY (DC)
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:
Last Name:SIU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:TOMMY
Other - Middle Name:
Other - Last Name:SIU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1946 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1142
Mailing Address - Country:US
Mailing Address - Phone:415-902-4850
Mailing Address - Fax:
Practice Address - Street 1:5651 PARADISE DR
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1858
Practice Address - Country:US
Practice Address - Phone:415-902-4850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor