Provider Demographics
NPI:1013193937
Name:WANG CHIROPRACTIC & ACUPUNCTURE CLINIC PC
Entity Type:Organization
Organization Name:WANG CHIROPRACTIC & ACUPUNCTURE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:1630-941-1234
Mailing Address - Street 1:552 S YORK ST # A
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-4479
Mailing Address - Country:US
Mailing Address - Phone:163-094-1123
Mailing Address - Fax:
Practice Address - Street 1:552 S YORK ST # A
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-4479
Practice Address - Country:US
Practice Address - Phone:163-094-1123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38008961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213557Medicare PIN