Provider Demographics
NPI:1447858956
Name:WIGGINS, MARY THONGPHIAN (DC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:THONGPHIAN
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10468 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-2829
Mailing Address - Country:US
Mailing Address - Phone:510-525-8611
Mailing Address - Fax:
Practice Address - Street 1:10468 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-2829
Practice Address - Country:US
Practice Address - Phone:510-525-8611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor