Healthcare Provider Details

I. General information

NPI: 1740298157
Provider Name (Legal Business Name): CHUN WONG DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 MERCHANT DR
ALGONQUIN IL
60102-5917
US

IV. Provider business mailing address

106 BATISTA CT
PALM DESERT CA
92211-0796
US

V. Phone/Fax

Practice location:
  • Phone: 847-854-8052
  • Fax:
Mailing address:
  • Phone: 760-979-3236
  • Fax: 801-650-1167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number038009161
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number038009161
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: