Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 60659 | OR |
Y | 213ES0000X | Sports Medicine | 60659 | OR |
NPI | 1558619148 |
---|---|
Provider Name | Dr. Neville Chu |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Portland, OR 97219-3583 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2012 |
Last Update Date | 28/09/2020 |