Provider Demographics
NPI:1073538997
Name:PEREZ, DIONYSIS WONG (DC)
Entity Type:Individual
Prefix:DR
First Name:DIONYSIS
Middle Name:WONG
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:DAN
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:500 BOLLINGER CANYON WAY
Mailing Address - Street 2:SUITE A-15
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5251
Mailing Address - Country:US
Mailing Address - Phone:925-735-8508
Mailing Address - Fax:844-272-5913
Practice Address - Street 1:500 BOLLINGER CANYON WAY
Practice Address - Street 2:SUITE A-15
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-5251
Practice Address - Country:US
Practice Address - Phone:925-735-8508
Practice Address - Fax:844-272-5913
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24199111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC024199Medicare ID - Type Unspecified