Provider Demographics
NPI:1326258377
Name:CHONG, ILENE (DC)
Entity Type:Individual
Prefix:DR
First Name:ILENE
Middle Name:
Last Name:CHONG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17607 SHERMAN WAY STE 202
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3500
Mailing Address - Country:US
Mailing Address - Phone:818-881-1777
Mailing Address - Fax:818-881-1778
Practice Address - Street 1:17607 SHERMAN WAY STE 202
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3500
Practice Address - Country:US
Practice Address - Phone:818-881-1777
Practice Address - Fax:818-881-1778
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor