MEDICARE: MR. BLAKE K WU D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	11670	TX

General Provider Information

NPI Number	:	1114219664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BLAKE K WU D.C.

Provider Business Mailing Address
First Line	:	4302 W LOVERS LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75209-2804
Country	:	US
Telephone Number	:	214-862-1469
Fax Number	:	855-950-0085

Provider Business Practice Location Address
First Line	:	4302 W LOVERS LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75209-2804
Country	:	US
Telephone Number	:	214-862-1469
Fax Number	:	855-950-0085

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2011
Last Update Date	:	02/26/2020

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