1073807566 NPI number — LEONARD WONG CHIROPRACTIC CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073807566 NPI number — LEONARD WONG CHIROPRACTIC CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEONARD WONG CHIROPRACTIC CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073807566
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2230 SUNSET BLVD
Provider Second Line Business Mailing Address:
360
Provider Business Mailing Address City Name:
ROCKLIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-786-7779
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2230 SUNSET BLVD STE 360
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKLIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95765-4274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-786-7779
Provider Business Practice Location Address Fax Number:
916-244-7066
Provider Enumeration Date:
06/02/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WONG
Authorized Official First Name:
LEONARD
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
916-786-7779

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  25827 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)