Healthcare Provider Details

I. General information

NPI: 1982425625
Provider Name (Legal Business Name): GIDEON CHEN CHIROPRACTIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
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: 909-227-2111
  • Fax:
Mailing address:
  • Phone: 909-227-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: GIDEON CHEN
Title or Position: CHIROPRACTIC
Credential: DC
Phone: 909-227-2111