Healthcare Provider Details

I. General information

NPI: 1952633679
Provider Name (Legal Business Name): ACME HEALTH GROUP CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W ROUTE 66 STE 106
GLENDORA CA
91740-6250
US

IV. Provider business mailing address

130 W ROUTE 66 STE 106
GLENDORA CA
91740-6250
US

V. Phone/Fax

Practice location:
  • Phone: 626-387-7229
  • Fax: 626-914-4600
Mailing address:
  • Phone: 626-387-7229
  • Fax: 626-914-4600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CHUNG-PO PETER WANG
Title or Position: PRESIDENT
Credential: D.C., L.AC.
Phone: 626-387-7229