MEDICARE: DR. GLENN GEE WONG D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC 28604	CA

General Provider Information

NPI Number	:	1235203068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN GEE WONG D.C.

Provider Business Mailing Address
First Line	:	8265 VILLAGE PKWY STE C
Second Line	:
City	:	DUBLIN
State	:	CA
Zip	:	94568-1254
Country	:	US
Telephone Number	:	925-803-8383
Fax Number	:	925-803-8118

Provider Business Practice Location Address
First Line	:	8265 VILLAGE PKWY STE C
Second Line	:
City	:	DUBLIN
State	:	CA
Zip	:	94568-1254
Country	:	US
Telephone Number	:	925-803-8383
Fax Number	:	925-803-8118

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	11/05/2010

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