Organization
GREENLIFE WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DERRICK TANG D.C. (CLINIC DIRECTOR)
(626) 297-2340
Entity
Organization
Contact information
Practice address
4018 ROSEMEAD BLVD, ROSEMEAD, CA 91770-4401
(626) 297-2340
Mailing address
4018 ROSEMEAD BLVD, ROSEMEAD, CA 91770-4401
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
—
—
111NS0005X
Sports Physician Chiropractor
—
—
111NX0800X
Orthopedic Chiropractor
Primary
27175
CA
Other
Enumeration date
05/07/2009
Last updated
05/07/2009
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