Provider Demographics
NPI:1194091983
Name:PETER WANG CHIROPRACTIC CORP.
Entity type:Organization
Organization Name:PETER WANG CHIROPRACTIC CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUNG-PO
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC
Authorized Official - Phone:626-442-0800
Mailing Address - Street 1:9939 GARVEY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-4712
Mailing Address - Country:US
Mailing Address - Phone:626-442-0800
Mailing Address - Fax:626-442-3800
Practice Address - Street 1:9939 GARVEY AVE STE B
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-4712
Practice Address - Country:US
Practice Address - Phone:626-442-0800
Practice Address - Fax:626-442-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 31223111N00000X
CAAC 13178171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty