Healthcare Provider Details

I. General information

NPI: 1891788469
Provider Name (Legal Business Name): DEBORAH WU D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 CENTRE ST
JAMAICA PLAIN MA
02130-3045
US

IV. Provider business mailing address

PO BOX 320258
WEST ROXBURY MA
02132-0003
US

V. Phone/Fax

Practice location:
  • Phone: 617-413-8362
  • Fax:
Mailing address:
  • Phone: 617-413-8362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMA1405
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: