Provider Demographics
NPI:1851701031
Name:HUO, WAYNE (LAC, DC)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:
Last Name:HUO
Suffix:
Gender:M
Credentials:LAC, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 S HACIENDA BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-4265
Mailing Address - Country:US
Mailing Address - Phone:626-855-1158
Mailing Address - Fax:626-605-5015
Practice Address - Street 1:2020 S HACIENDA BLVD STE D
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-4265
Practice Address - Country:US
Practice Address - Phone:626-855-1158
Practice Address - Fax:626-605-5015
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16081171100000X
CADC36008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist