=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336713767
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIU CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2021
-----------------------------------------------------
Last Update Date | 03/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5651 PARADISE DR
-----------------------------------------------------
City | CORTE MADERA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94925-1858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-902-4580
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1946 29TH AVE
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94116-1142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-902-4850
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | TOMMY SIU
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 415-652-0688
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------