Healthcare Provider Details

I. General information

NPI: 1003139239
Provider Name (Legal Business Name): RADIANT CHIROPRACTIC AND ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 E REMINGTON DR SUITE C
SUNNYVALE CA
94087-2995
US

IV. Provider business mailing address

860 E REMINGTON DR SUITE C
SUNNYVALE CA
94087-2995
US

V. Phone/Fax

Practice location:
  • Phone: 510-823-4988
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 29274
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 12302
License Number StateCA

VIII. Authorized Official

Name: TONY MING WOO
Title or Position: CHIROPRACTOR AND ACUPUNCTURIST
Credential: D.C., LAC
Phone: 510-823-4988