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General NPI Number Information
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NPI Number | 1063123594
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Entity Type | Organization
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Legal Business Name | CLARK WANG CHIROPRACTIC INC.
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Dates
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Enumeration Date | 12/06/2022
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 24953 PASEO DE VALENCIA STE 6A
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-4342
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Country | US
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Telephone | 949-643-5030
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Fax | 949-643-5209
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Provider Business Mailing Address
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Address Line | 24953 PASEO DE VALENCIA STE 6A
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-4342
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Country | US
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Telephone | 949-643-5030
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Fax | 949-643-5209
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. RYAN P CLARK
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Credential | DC
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Telephone | 949-643-5030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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