Provider Demographics
NPI:1629718044
Name:XIONG, CHIENKONG (DC)
Entity Type:Individual
Prefix:
First Name:CHIENKONG
Middle Name:
Last Name:XIONG
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 1:6240 152ND AVE NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-9123
Mailing Address - Country:US
Mailing Address - Phone:763-445-0974
Mailing Address - Fax:
Practice Address - Street 1:6240 152ND AVE NW
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-9123
Practice Address - Country:US
Practice Address - Phone:763-445-0974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor