Healthcare Provider Details

I. General information

NPI: 1841379757
Provider Name (Legal Business Name): DAVID WU DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13768 ROSWELL AVE STE 209
CHINO CA
91710-1406
US

IV. Provider business mailing address

13768 ROSWELL AVE STE 209
CHINO CA
91710-1406
US

V. Phone/Fax

Practice location:
  • Phone: 909-396-9500
  • Fax: 909-752-4175
Mailing address:
  • Phone: 909-396-9500
  • Fax: 909-752-4175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC21572
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberDC21572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: