Provider Demographics
NPI:1780770602
Name:WONG, STEVEN L (D C)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:L
Last Name:WONG
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 W MEADOW AVE
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-2247
Mailing Address - Country:US
Mailing Address - Phone:559-625-2466
Mailing Address - Fax:559-625-2468
Practice Address - Street 1:1821 W MEADOW AVE
Practice Address - Street 2:SUITE A-2
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-2247
Practice Address - Country:US
Practice Address - Phone:559-625-2466
Practice Address - Fax:559-625-2468
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0154420Medicare ID - Type Unspecified