Provider Demographics
NPI:1508866500
Name:WONG, JEFFREY M C (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M C
Last Name:WONG
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 1:301 CARRIE CT
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-9096
Mailing Address - Country:US
Mailing Address - Phone:630-584-8729
Mailing Address - Fax:855-442-7883
Practice Address - Street 1:2560 FOXFIELD RD
Practice Address - Street 2:SUITE 140
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1488
Practice Address - Country:US
Practice Address - Phone:630-584-8729
Practice Address - Fax:855-442-7883
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2015-06-22
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-06-27
Provider Licenses
StateLicense IDTaxonomies
IL038-007475111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU49783Medicare UPIN
IL574460Medicare ID - Type Unspecified