Provider Demographics
NPI:1366907743
Name:DR T LAU CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:DR T LAU CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:W
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:510-684-1281
Mailing Address - Street 1:630 THOMAS L BERKLEY WAY APT 507
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1865
Mailing Address - Country:US
Mailing Address - Phone:510-684-1281
Mailing Address - Fax:
Practice Address - Street 1:1911 ADDISON ST STE 101
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1267
Practice Address - Country:US
Practice Address - Phone:510-981-8348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-10
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4193OtherLICENSE