Healthcare Provider Details

I. General information

NPI: 1306818398
Provider Name (Legal Business Name): WEN WU D.C , D.O.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 WYOMING BLVD NE
ALBUQUERQUE NM
87111-4540
US

IV. Provider business mailing address

2709 WYOMING BLVD NE
ALBUQUERQUE NM
87111-4540
US

V. Phone/Fax

Practice location:
  • Phone: 505-294-5486
  • Fax: 505-294-3655
Mailing address:
  • Phone: 505-294-5486
  • Fax: 505-294-3655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1039
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number061
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: