Provider Demographics
NPI:1245366566
Name:PAUL WONG CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:PAUL WONG CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:WING-YIU
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:626-282-1106
Mailing Address - Street 1:1101 W VALLEY BLVD
Mailing Address - Street 2:STE.207
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-2462
Mailing Address - Country:US
Mailing Address - Phone:626-282-1106
Mailing Address - Fax:626-282-1226
Practice Address - Street 1:1101 W VALLEY BLVD
Practice Address - Street 2:STE.207
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-2462
Practice Address - Country:US
Practice Address - Phone:626-282-1106
Practice Address - Fax:626-282-1226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15076111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC15076AMedicare ID - Type Unspecified
CAT17970Medicare UPIN