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General NPI Number Information
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NPI Number | 1508963943
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Entity Type | Individual
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Provider Name | PHU Q LA D.C.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 01/07/2008
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Provider Practice Location Address
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Address Line | 12234 HAVEN CIR
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City | RIVERSIDE
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State | CA
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Zip | 92503-5982
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Country | US
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Telephone | 951-227-9780
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Fax |
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Provider Business Mailing Address
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Address Line | 12620 ERICKSON AVE STE. B
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City | DOWNEY
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State | CA
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Zip | 90242-4013
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Country | US
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Telephone | 951-227-9780
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC-29308
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License Number State | CA
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