Healthcare Provider Details

I. General information

NPI: 1194091983
Provider Name (Legal Business Name): PETER WANG CHIROPRACTIC CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9939 GARVEY AVE STE B
EL MONTE CA
91733-4712
US

IV. Provider business mailing address

9939 GARVEY AVE STE B
EL MONTE CA
91733-4712
US

V. Phone/Fax

Practice location:
  • Phone: 626-442-0800
  • Fax: 626-442-3800
Mailing address:
  • Phone: 626-442-0800
  • Fax: 626-442-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 31223
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 13178
License Number StateCA

VIII. Authorized Official

Name: DR. CHUNG-PO PETER WANG
Title or Position: PRESIDENT
Credential: DC, LAC
Phone: 626-442-0800