Provider Demographics
NPI:1831314509
Name:LUM, PATRICK K (DC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:K
Last Name:LUM
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 1:1314 LINCOLN AVE STE 2F
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-3012
Mailing Address - Country:US
Mailing Address - Phone:408-975-9753
Mailing Address - Fax:408-297-0733
Practice Address - Street 1:1314 LINCOLN AVE STE 2F
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-3012
Practice Address - Country:US
Practice Address - Phone:408-975-9753
Practice Address - Fax:408-297-0733
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABF440ZMedicare PIN