Healthcare Provider Details

I. General information

NPI: 1699542928
Provider Name (Legal Business Name): GIDEON CHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10399 FOOTHILL BLVD STE 104
RANCHO CUCAMONGA CA
91730-6957
US

IV. Provider business mailing address

10399 FOOTHILL BLVD STE 104
RANCHO CUCAMONGA CA
91730-6957
US

V. Phone/Fax

Practice location:
  • Phone: 909-466-8800
  • Fax: 909-466-0088
Mailing address:
  • Phone: 909-466-8800
  • Fax: 909-466-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number36597
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: