MEDICARE: DR. WEN WU D.C , D.O.M

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	1039	NM
2	171100000X	Acupuncturist	061	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NM00R462	OTHER	NM	BCBSNM

General Provider Information

NPI Number	:	1306818398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WEN WU D.C , D.O.M

Provider Business Mailing Address
First Line	:	2709 WYOMING BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-4540
Country	:	US
Telephone Number	:	505-294-5486
Fax Number	:	505-294-3655

Provider Business Practice Location Address
First Line	:	2709 WYOMING BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-4540
Country	:	US
Telephone Number	:	505-294-5486
Fax Number	:	505-294-3655

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	05/02/2011

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