Provider Demographics
NPI:1639436330
Name:NGO, CHRISTOPHER S (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:S
Last Name:NGO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17014 NEW COLLEGE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1177
Mailing Address - Country:US
Mailing Address - Phone:618-235-8422
Mailing Address - Fax:
Practice Address - Street 1:17014 NEW COLLEGE AVE STE B
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1177
Practice Address - Country:US
Practice Address - Phone:618-235-8422
Practice Address - Fax:618-235-8427
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.130265204D00000X
MO2010019783204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM