Provider Demographics
NPI:1225329477
Name:WONG, HARVEY J (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:J
Last Name:WONG
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 S 5TH ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4737
Mailing Address - Country:US
Mailing Address - Phone:909-747-9608
Mailing Address - Fax:
Practice Address - Street 1:17 S 5TH ST
Practice Address - Street 2:SUITE #1
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4737
Practice Address - Country:US
Practice Address - Phone:909-747-9608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31896111N00000X
CAAC14246171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist