Healthcare Provider Details

I. General information

NPI: 1881945822
Provider Name (Legal Business Name): HONG CHIROPRACTIC, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 W VALLEY BLVD
COLTON CA
92324-2249
US

IV. Provider business mailing address

556 W VALLEY BLVD
COLTON CA
92324-2249
US

V. Phone/Fax

Practice location:
  • Phone: 909-824-1234
  • Fax: 909-423-0510
Mailing address:
  • Phone: 909-824-1234
  • Fax: 909-423-0510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC-14585
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-30750
License Number StateCA

VIII. Authorized Official

Name: DR. KENNETH H HONG
Title or Position: PRESIDENT
Credential: D.C.
Phone: 909-824-1234