Provider Demographics
NPI:1104922103
Name:JIMMY WU CHIROPRACTIC CORP.
Entity type:Organization
Organization Name:JIMMY WU CHIROPRACTIC CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:CHUNG-TE
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:626-330-8899
Mailing Address - Street 1:15722 GALE AVE
Mailing Address - Street 2:#A
Mailing Address - City:HACIENDA HTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-1518
Mailing Address - Country:US
Mailing Address - Phone:626-330-8899
Mailing Address - Fax:626-330-8699
Practice Address - Street 1:15722 EAST GALE AVE
Practice Address - Street 2:#A
Practice Address - City:HACIENDA HTS
Practice Address - State:CA
Practice Address - Zip Code:91745-1518
Practice Address - Country:US
Practice Address - Phone:626-330-8899
Practice Address - Fax:626-330-8699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24672111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU76762Medicare ID - Type Unspecified