Provider Demographics
NPI:1013972256
Name:WONG, L RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:L
Middle Name:RICHARD
Last Name:WONG
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 1:9011 N MERIDIAN ST
Mailing Address - Street 2:SUITE 135
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5378
Mailing Address - Country:US
Mailing Address - Phone:317-844-0028
Mailing Address - Fax:317-844-0906
Practice Address - Street 1:9011 N MERIDIAN ST
Practice Address - Street 2:SUITE 135
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5378
Practice Address - Country:US
Practice Address - Phone:317-844-0028
Practice Address - Fax:317-844-0906
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000902A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor