Active NPI
Richard Gary Wong, DC
- Chiropractor
- Santa Rosa, CA
National Provider Identifier
1356444277
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 15077
- Practice address
- 205 8TH St
Santa Rosa, CA 95401-6206 - Phone
- (707) 578-4110
- Fax
- (707) 578-1016
- NPI assigned
- Sep 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 15077 | CA | Primary |
Addresses
Primary practice location
205 8TH St
Santa Rosa, CA 95401-6206
Mailing address
205 8TH St
Santa Rosa, CA 95401-6206
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100302000260 | CA | Practitioner - Chiropractic | 6901941970 | Practice locations: Santa Rosa, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - West Sunnyvale, 1981
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
205 8TH St
Santa Rosa, CA 95401-6206
Phone (707) 578-4110
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15077 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389052800000",
"number": "1356444277",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "205 8TH ST",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954016206"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 8TH ST",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954016206",
"telephone_number": "707-578-4110",
"fax_number": "707-578-1016"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "RICHARD",
"middle_name": "GARY",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-06",
"last_updated": "2014-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "15077",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.