Provider Demographics
NPI:1659451615
Name:MICHAEL C. WANG CHIROPRACTIC AND ACUPUNCTURE INC.
Entity Type:Organization
Organization Name:MICHAEL C. WANG CHIROPRACTIC AND ACUPUNCTURE INC.
Other - Org Name:GATEWAY CHIROPRACTIC & ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC
Authorized Official - Phone:951-808-8320
Mailing Address - Street 1:1260 HAMNER AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-3136
Mailing Address - Country:US
Mailing Address - Phone:951-808-8320
Mailing Address - Fax:951-808-8313
Practice Address - Street 1:1260 HAMNER AVE
Practice Address - Street 2:SUITE E
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3136
Practice Address - Country:US
Practice Address - Phone:951-808-8320
Practice Address - Fax:951-808-8313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26509111N00000X
CAAC9069171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU99302Medicare UPIN
CADC0265090Medicare ID - Type Unspecified