Provider Demographics
NPI:1073083721
Name:HWANG, WONTAEK (DC)
Entity Type:Individual
Prefix:DR
First Name:WONTAEK
Middle Name:
Last Name:HWANG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S MILWAUKEE AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-5072
Mailing Address - Country:US
Mailing Address - Phone:847-497-5003
Mailing Address - Fax:
Practice Address - Street 1:401 S MILWAUKEE AVE STE 210
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-5072
Practice Address - Country:US
Practice Address - Phone:847-497-5003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013224111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor