Provider Demographics
NPI:1710903737
Name:WANG, ANNIE C (DC)
Entity Type:Individual
Prefix:MS
First Name:ANNIE
Middle Name:C
Last Name:WANG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 A YORK RD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126
Mailing Address - Country:US
Mailing Address - Phone:630-941-1234
Mailing Address - Fax:630-530-5869
Practice Address - Street 1:552 A YORK RD
Practice Address - Street 2:WANG CHIROPRACTIC & ACUPUNCTURE CLINIC
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126
Practice Address - Country:US
Practice Address - Phone:630-941-1234
Practice Address - Fax:630-530-5869
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213557Medicare ID - Type Unspecified