Provider Demographics
NPI:1639394729
Name:WONG, SERGIO (DC)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:
Last Name:WONG
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 1:17514 N TEMPE CIR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-6916
Mailing Address - Country:US
Mailing Address - Phone:832-723-4123
Mailing Address - Fax:
Practice Address - Street 1:11514 FALLBROOK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4239
Practice Address - Country:US
Practice Address - Phone:281-955-9946
Practice Address - Fax:281-469-0439
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8879111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor