Provider Demographics
NPI:1669564001
Name:WONG, ALLAN S (DC, LAC)
Entity type:Individual
Prefix:MR
First Name:ALLAN
Middle Name:S
Last Name:WONG
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 S. GARFIELD AVE
Mailing Address - Street 2:SUITE #208
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801
Mailing Address - Country:US
Mailing Address - Phone:626-380-0836
Mailing Address - Fax:626-282-0932
Practice Address - Street 1:330 S. GARFIELD AVE
Practice Address - Street 2:SUITE #208
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801
Practice Address - Country:US
Practice Address - Phone:626-380-0836
Practice Address - Fax:626-282-0932
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29408111N00000X
CA10593171100000X
CADC29408111N00000X
CAAC10593171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist