Provider Demographics
NPI:1053435214
Name:DR. JERRY WANG, D.C., P.S., INC.
Entity type:Organization
Organization Name:DR. JERRY WANG, D.C., P.S., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-688-1994
Mailing Address - Street 1:1750 112TH AVE NE STE C240
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5233
Mailing Address - Country:US
Mailing Address - Phone:425-688-1994
Mailing Address - Fax:425-688-1990
Practice Address - Street 1:1750 112TH AVE NE STE C240
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5233
Practice Address - Country:US
Practice Address - Phone:425-688-1994
Practice Address - Fax:425-688-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3517111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty