Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 038003262 | IL |
NPI | 1619970613 |
---|---|
Provider Name | Dr. Leon Robert Wleklinski |
First Address | Park Ridge, IL 60068-1342 |
Second Address | Park Ridge, IL 60068-1342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 20/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
038003262 | (05) | IL |
1682237 | BLUE CROSS BLUE SHIELD (01) | IL |
T36412 | (02) | IL |