Provider Demographics
NPI:1073807566
Name:LEONARD WONG CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:LEONARD WONG CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-786-7779
Mailing Address - Street 1:729 SUNRISE AVE STE 501
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4526
Mailing Address - Country:US
Mailing Address - Phone:916-786-7779
Mailing Address - Fax:916-330-4567
Practice Address - Street 1:729 SUNRISE AVE STE 501
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4526
Practice Address - Country:US
Practice Address - Phone:916-786-7779
Practice Address - Fax:916-330-4567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25827111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0258270Medicare PIN