Provider Demographics
NPI:1609592542
Name:LIEU, VINSON (DC)
Entity Type:Individual
Prefix:
First Name:VINSON
Middle Name:
Last Name:LIEU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21565 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-2145
Mailing Address - Country:US
Mailing Address - Phone:510-398-8082
Mailing Address - Fax:510-397-2522
Practice Address - Street 1:21565 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-2145
Practice Address - Country:US
Practice Address - Phone:510-398-8082
Practice Address - Fax:510-397-2522
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor