MEDICARE: LORI S. CHONG RD, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	3407	OH

General Provider Information

NPI Number	:	1407133580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI S. CHONG RD, LD

Provider Business Mailing Address
First Line	:	700 ACKERMAN RD
Second Line	:	SUITE 570
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1559
Country	:	US
Telephone Number	:	614-293-2046
Fax Number	:

Provider Business Practice Location Address
First Line	:	1727 BETHEL RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-1836
Country	:	US
Telephone Number	:	614-293-2334
Fax Number	:	614-293-2335

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2011
Last Update Date	:	07/16/2015

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