Provider Demographics
NPI:1942415229
Name:WONG, BRANDON CHRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:CHRISTOPHER
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 1:1619 E MCDOWELL RD STE C
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-4458
Mailing Address - Country:US
Mailing Address - Phone:602-334-1064
Mailing Address - Fax:602-354-3655
Practice Address - Street 1:1619 E MCDOWELL RD STE C
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-4458
Practice Address - Country:US
Practice Address - Phone:602-334-1064
Practice Address - Fax:602-354-3655
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7826111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor