Provider Demographics
NPI:1255023065
Name:WONG MOMENTUM CHIROPRACTIC CORP
Entity type:Organization
Organization Name:WONG MOMENTUM CHIROPRACTIC CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:D.C.
Authorized Official - Prefix:
Authorized Official - First Name:WING
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-269-7111
Mailing Address - Street 1:1711 BRANHAM LN STE A12
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-5212
Mailing Address - Country:US
Mailing Address - Phone:408-269-7111
Mailing Address - Fax:408-269-7110
Practice Address - Street 1:1711 BRANHAM LN STE A12
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-5212
Practice Address - Country:US
Practice Address - Phone:408-269-7111
Practice Address - Fax:408-269-7110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty