Provider Demographics
NPI:1740768472
Name:LAU, JULIE (DC)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:LAU
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 1:23441 S POINTE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1522
Mailing Address - Country:US
Mailing Address - Phone:949-600-7988
Mailing Address - Fax:949-716-6969
Practice Address - Street 1:23441 S POINTE DR STE 100
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1522
Practice Address - Country:US
Practice Address - Phone:949-600-7988
Practice Address - Fax:949-716-6969
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34249111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA34249OtherDC
CACB376237Medicaid