Provider Demographics
NPI:1578876645
Name:WANG ACU-CHIRPRACTIC CLINIC, PC
Entity Type:Organization
Organization Name:WANG ACU-CHIRPRACTIC CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUAN-MIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-932-1274
Mailing Address - Street 1:2S065 HAMPTON LN
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5112
Mailing Address - Country:US
Mailing Address - Phone:630-932-1274
Mailing Address - Fax:630-932-4024
Practice Address - Street 1:2S065 HAMPTON LN
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5112
Practice Address - Country:US
Practice Address - Phone:630-932-1274
Practice Address - Fax:630-932-4024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008809302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU77410Medicare UPIN