Provider Demographics
NPI:1487746301
Name:WABOMNOR, JOSEPH CHUKA (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CHUKA
Last Name:WABOMNOR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4167
Mailing Address - Country:US
Mailing Address - Phone:773-252-0800
Mailing Address - Fax:773-252-0881
Practice Address - Street 1:2075 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4167
Practice Address - Country:US
Practice Address - Phone:773-252-0800
Practice Address - Fax:773-252-0881
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009465111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1627996OtherBCBS IL
IL971830Medicare ID - Type Unspecified