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General NPI Number Information
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NPI Number | 1902920408
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Entity Type | Organization
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Legal Business Name | WANG WELLNESS CLINIC, P.S., INC.
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4629 168TH STREET SW STB
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City | LYNNWOOD
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State | WA
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Zip | 98037
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Country | US
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Telephone | 425-688-1994
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Fax | 425-688-1990
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Provider Business Mailing Address
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Address Line | 555 116TH AVE NE STE 116
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City | BELLEVUE
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State | WA
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Zip | 98004-5233
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Country | US
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Telephone | 425-688-1994
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Fax | 425-688-1990
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JERRY WANG
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Credential | D.C.
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Telephone | 425-688-1994
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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 | 3517
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License Number State | WA
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