Basic Information
Provider Information
NPI: 1558619148
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHU
FirstName: NEVILLE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.P.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 790 REMINGTON BLVD
Address2:  
City: BOLINGBROOK
State: IL
PostalCode: 604404909
CountryCode: US
TelephoneNumber: 6302962223
FaxNumber: 6307599510
Practice Location
Address1: 4356 SW MULTNOMAH BLVD
Address2:  
City: PORTLAND
State: OR
PostalCode: 972193583
CountryCode: US
TelephoneNumber: 5036109281
FaxNumber: 9713397071
Other Information
ProviderEnumerationDate: 08/29/2012
LastUpdateDate: 09/28/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/28/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2081S0010X60659ORY Allopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine

No ID Information.


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