Provider Demographics
NPI:1619970613
Name:WLEKLINSKI, LEON ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:ROBERT
Last Name:WLEKLINSKI
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 1:1420 RENAISSANCE DR
Mailing Address - Street 2:STE 206
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1342
Mailing Address - Country:US
Mailing Address - Phone:847-298-3565
Mailing Address - Fax:847-298-3770
Practice Address - Street 1:1420 RENAISSANCE DR
Practice Address - Street 2:STE 206
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1342
Practice Address - Country:US
Practice Address - Phone:847-298-3565
Practice Address - Fax:847-298-3770
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038003262111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038003262Medicaid
IL1682237OtherBLUE CROSS BLUE SHIELD
IL038003262Medicaid
IL1682237OtherBLUE CROSS BLUE SHIELD