Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 038-007475 | IL |
NPI | 1508866500 |
---|---|
Provider Name | Dr. Jeffrey M C Wong |
First Address | North Aurora, IL 60542-9096 |
Second Address | St Charles, IL 60174-1488 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2005 |
Last Update Date | 22/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U49783 | (02) | IL |