Provider Demographics
NPI:1578624896
Name:CHIU, CHARLOTTE (DC)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:CHIU
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10441 WHITCOMB WAY
Mailing Address - Street 2:#145
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127
Mailing Address - Country:US
Mailing Address - Phone:858-361-3158
Mailing Address - Fax:
Practice Address - Street 1:5230 CARROLL CANYON RD
Practice Address - Street 2:#330
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1778
Practice Address - Country:US
Practice Address - Phone:858-581-3568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor