MEDICARE: JIMMY CHUNG-TE 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	DC24672	CA

General Provider Information

NPI Number	:	1770689846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMMY CHUNG-TE WU D.C.

Provider Business Mailing Address
First Line	:	1595 FULTON AVE
Second Line	:
City	:	MONTEREY PARK
State	:	CA
Zip	:	91755-5601
Country	:	US
Telephone Number	:	626-571-5257
Fax Number	:

Provider Business Practice Location Address
First Line	:	15722 GALE AVE
Second Line	:	#A
City	:	HACIENDA HTS
State	:	CA
Zip	:	91745-1518
Country	:	US
Telephone Number	:	626-330-8899
Fax Number	:	626-330-8699

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	07/08/2007

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