Provider Demographics
NPI:1619384575
Name:WRIGHT, PHRANQUE (DAOM)
Entity Type:Individual
Prefix:DR
First Name:PHRANQUE
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 N BROADWAY ST
Mailing Address - Street 2:107
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-6074
Mailing Address - Country:US
Mailing Address - Phone:708-297-5899
Mailing Address - Fax:
Practice Address - Street 1:4007 N BROADWAY ST
Practice Address - Street 2:107
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-6074
Practice Address - Country:US
Practice Address - Phone:708-297-5899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000782171100000X
WI578-055171100000X
CO578171100000X
IN84000096A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist