Individual
MS. NISA WONGTHIPKONGKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.AC.
Contact information
Practice address
1650 W FARWELL AVE, CHICAGO, IL 60626-3695
(312) 718-8080
Mailing address
1650 W FARWELL AVE, CHICAGO, IL 60626-3695
(312) 718-8080
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
198001170
IL
Other
Enumeration date
10/24/2016
Last updated
10/24/2016
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