Provider Demographics
NPI:1245240621
Name:MABEL M P CHAU DC A CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:MABEL M P CHAU DC A CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MABEL
Authorized Official - Middle Name:M P
Authorized Official - Last Name:CHAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-956-5165
Mailing Address - Street 1:1415 E COLORADO ST STE 209
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1541
Mailing Address - Country:US
Mailing Address - Phone:818-956-5165
Mailing Address - Fax:
Practice Address - Street 1:1415 E COLORADO ST STE 209
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1541
Practice Address - Country:US
Practice Address - Phone:818-956-5165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14257171100000X
CADC12630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC12630OtherCHIROPRACTIC