Provider Demographics
NPI:1942211347
Name:SU, EUGENE MING (DC, MAOM)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:MING
Last Name:SU
Suffix:
Gender:M
Credentials:DC, MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44330 PREMIER PLZ
Mailing Address - Street 2:#110
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5070
Mailing Address - Country:US
Mailing Address - Phone:703-723-9355
Mailing Address - Fax:703-723-6647
Practice Address - Street 1:5901 SW 74TH ST
Practice Address - Street 2:#220
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5165
Practice Address - Country:US
Practice Address - Phone:855-692-9362
Practice Address - Fax:703-723-6647
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA004126442205111N00000X
FL10465111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA492142Medicare ID - Type UnspecifiedCHIROPRACTIC