Provider Demographics
NPI:1841379757
Name:WU, DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:WU
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 1:13768 ROSWELL AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1406
Mailing Address - Country:US
Mailing Address - Phone:909-396-9500
Mailing Address - Fax:909-752-4175
Practice Address - Street 1:13768 ROSWELL AVE STE 209
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1406
Practice Address - Country:US
Practice Address - Phone:909-396-9500
Practice Address - Fax:909-752-4175
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21572111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC21572OtherBOARD OF CHIROPRACTIC EXAMINERS LICENSE NO.
CAWDC21572AMedicare ID - Type Unspecified