Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 12096 | TX |
N | 111NR0400X | Rehabilitation Chiropractor | 12096 | TX |
NPI | 1235489568 |
---|---|
Provider Name | Eric Wu |
First Address | Austin, TX 78750 |
Second Address | Austin, TX 78750 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2012 |
Last Update Date | 13/09/2012 |