=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790930683
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WALNUT NATURAL HEALTH CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2008
-----------------------------------------------------
Last Update Date | 11/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18710 AMAR RD SUITE C
-----------------------------------------------------
City | WALNUT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91789-4571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-839-8578
-----------------------------------------------------
Fax | 626-839-7001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18710 AMAR RD SUITE C
-----------------------------------------------------
City | WALNUT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91789-4571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-839-8578
-----------------------------------------------------
Fax | 626-839-7001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | MRS. MANLI WU
-----------------------------------------------------
Credential | D.C, L. AC.
-----------------------------------------------------
Telephone | 626-839-8578
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC9113
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC30187
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------