Provider Demographics
NPI:1053816421
Name:WONG, ALICIA (DC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4348 WAIALAE AVE
Mailing Address - Street 2:PMB 247
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816
Mailing Address - Country:US
Mailing Address - Phone:808-388-7682
Mailing Address - Fax:808-200-3607
Practice Address - Street 1:94-1221 KA UKA BLVD # B205
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-6202
Practice Address - Country:US
Practice Address - Phone:808-388-7682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-1408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor