Provider Demographics
NPI:1366540429
Name:CHU, JOHNNY M (DC)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:M
Last Name:CHU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21349 COLD SPRING LN
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3443
Mailing Address - Country:US
Mailing Address - Phone:909-595-1124
Mailing Address - Fax:909-595-1146
Practice Address - Street 1:21349 COLD SPRING LN
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3443
Practice Address - Country:US
Practice Address - Phone:909-595-1124
Practice Address - Fax:909-595-1146
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21922111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor