Provider Demographics
NPI:1356451629
Name:UONG, RENE ETHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:RENE
Middle Name:ETHAN
Last Name:UONG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2760 E SPRING ST STE 150
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2266
Mailing Address - Country:US
Mailing Address - Phone:562-424-1200
Mailing Address - Fax:562-424-1214
Practice Address - Street 1:2760 E SPRING ST STE 150
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2266
Practice Address - Country:US
Practice Address - Phone:562-424-1200
Practice Address - Fax:562-424-1214
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor