Healthcare Provider Details

I. General information

NPI: 1265666978
Provider Name (Legal Business Name): DARWIN VAN WYNGARDEN A PROFESSIONAL CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 05/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 W MAIN ST STE D
RIPON CA
95366-3030
US

IV. Provider business mailing address

1444 W MAIN ST STE D
RIPON CA
95366-3030
US

V. Phone/Fax

Practice location:
  • Phone: 209-599-2699
  • Fax: 209-599-5465
Mailing address:
  • Phone: 209-599-2699
  • Fax: 209-599-5465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 0196390
License Number StateCA

VIII. Authorized Official

Name: DR. DARWIN LEE VAN WYNGARDEN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 209-599-2699