Provider Demographics
NPI:1821215930
Name:HSU, MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:HSU
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 1:6540 LUSK BLVD
Mailing Address - Street 2:STE C216
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2766
Mailing Address - Country:US
Mailing Address - Phone:858-605-1603
Mailing Address - Fax:
Practice Address - Street 1:6540 LUSK BLVD
Practice Address - Street 2:STE C216
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2766
Practice Address - Country:US
Practice Address - Phone:858-605-1603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28796111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC28796OtherCHIROPRACTIC LICENSE