Provider Demographics
NPI:1710035134
Name:GONG, ROXANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:
Last Name:GONG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4437 MING AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-4817
Mailing Address - Country:US
Mailing Address - Phone:661-398-9100
Mailing Address - Fax:661-395-5188
Practice Address - Street 1:4437 MING AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-4817
Practice Address - Country:US
Practice Address - Phone:661-398-9100
Practice Address - Fax:661-395-5188
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27434111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor