Provider Demographics
NPI:1053409169
Name:CHIN, WILLARD (DC)
Entity type:Individual
Prefix:DR
First Name:WILLARD
Middle Name:
Last Name:CHIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:WILLARD
Other - Middle Name:
Other - Last Name:CHIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:3202 INGALLS ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-3508
Mailing Address - Country:US
Mailing Address - Phone:415-467-8924
Mailing Address - Fax:
Practice Address - Street 1:3 S LINDEN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-6407
Practice Address - Country:US
Practice Address - Phone:650-589-2647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 23637111NX0100X
CAAT3326225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23637OtherCHIROPRACTIC LICENSE
CAAT3326OtherPHYSICAL THERAPIST ASSIST