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General NPI Number Information
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NPI Number | 1225320252
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Entity Type | Organization
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Legal Business Name | DR WEN WU DC DOM LLC
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Dates
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Enumeration Date | 05/10/2011
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 2709 WYOMING BLVD NE SUITE A
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-4540
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Country | US
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Telephone | 505-294-5486
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Fax | 505-294-3655
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Provider Business Mailing Address
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Address Line | 2709 WYOMING BLVD NE SUITE A
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-4540
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Country | US
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Telephone | 505-294-5486
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Fax | 505-294-3655
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Authorized Official
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Title or Position | OWNER
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Name | DR. WEN C WU
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Credential | DC., DOM
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Telephone | 505-294-5486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 061
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1039
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License Number State | NM
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