Provider Demographics
NPI:1497023535
Name:WONG, LESLEY YAN (DC, LMT)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:YAN
Last Name:WONG
Suffix:
Gender:F
Credentials:DC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 E IRVING PARK RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-2303
Mailing Address - Country:US
Mailing Address - Phone:630-893-4000
Mailing Address - Fax:630-893-4000
Practice Address - Street 1:805 E IRVING PARK RD
Practice Address - Street 2:SUITE B
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-4320
Practice Address - Country:US
Practice Address - Phone:630-893-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-04
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012074111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor