Healthcare Provider Details

I. General information

NPI: 1114154135
Provider Name (Legal Business Name): SANDY C. LIU D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 06/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 SAN MARINO AVE. STE. 12
SAN MARINO CA
91108-2047
US

IV. Provider business mailing address

1427 SAN MARINO AVE. STE. 12
SAN MARINO CA
91108-2047
US

V. Phone/Fax

Practice location:
  • Phone: 626-441-6458
  • Fax:
Mailing address:
  • Phone: 626-441-6458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC26094
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: