Provider Demographics
NPI:1659796282
Name:LECUONA, ARIAN A (DC)
Entity Type:Individual
Prefix:DR
First Name:ARIAN
Middle Name:A
Last Name:LECUONA
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 1:1144 LAKE ST
Mailing Address - Street 2:203
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-6705
Mailing Address - Country:US
Mailing Address - Phone:708-406-9459
Mailing Address - Fax:708-383-4376
Practice Address - Street 1:1144 LAKE ST
Practice Address - Street 2:203
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-6705
Practice Address - Country:US
Practice Address - Phone:708-406-9459
Practice Address - Fax:708-383-4376
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012565111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation