Provider Demographics
NPI:1811156334
Name:WADE, TERENCE LEWUE (DC)
Entity type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:LEWUE
Last Name:WADE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:841 BLOSSOM HILL RD
Mailing Address - Street 2:STE. #107
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-2704
Mailing Address - Country:US
Mailing Address - Phone:408-229-8888
Mailing Address - Fax:408-229-8889
Practice Address - Street 1:841 BLOSSOM HILL RD
Practice Address - Street 2:STE. #107
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-2704
Practice Address - Country:US
Practice Address - Phone:408-229-8888
Practice Address - Fax:408-229-8889
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA18683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0186830Medicare PIN