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General NPI Number Information
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NPI Number | 1740414143
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Entity Type | Individual
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Provider Name | MARY PATRICIA VAN WYNGARDEN D.C.
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Gender | Female
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Dates
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Enumeration Date | 05/13/2009
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Last Update Date | 05/15/2013
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Provider Practice Location Address
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Address Line | 1444 W MAIN ST STE D
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City | RIPON
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State | CA
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Zip | 95366-3030
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Country | US
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Telephone | 209-599-2699
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Fax | 209-599-5465
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Provider Business Mailing Address
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Address Line | 1444 W MAIN ST STE D
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City | RIPON
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State | CA
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Zip | 95366
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Country | US
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Telephone | 209-599-2699
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Fax | 209-599-5465
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 27179
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License Number State | CA
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