Provider Demographics
NPI:1265666978
Name:DARWIN VAN WYNGARDEN A PROFESSIONAL CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:DARWIN VAN WYNGARDEN A PROFESSIONAL CHIROPRACTIC CORPORATION
Other - Org Name:ALMOND VALLEY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARWIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VAN WYNGARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-599-2699
Mailing Address - Street 1:1444 W MAIN ST
Mailing Address - Street 2:STE D
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366-3030
Mailing Address - Country:US
Mailing Address - Phone:209-599-2699
Mailing Address - Fax:209-599-5465
Practice Address - Street 1:1444 W MAIN ST
Practice Address - Street 2:STE D
Practice Address - City:RIPON
Practice Address - State:CA
Practice Address - Zip Code:95366-3030
Practice Address - Country:US
Practice Address - Phone:209-599-2699
Practice Address - Fax:209-599-5465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 0196390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty