Provider Demographics
NPI:1194920959
Name:CHEN, LEON L (OMD, LAC)
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:L
Last Name:CHEN
Suffix:
Gender:M
Credentials:OMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 S HIGHLAND AVE
Mailing Address - Street 2:SUITE 342
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5363
Mailing Address - Country:US
Mailing Address - Phone:163-091-6078
Mailing Address - Fax:163-091-6078
Practice Address - Street 1:2500 S HIGHLAND AVE
Practice Address - Street 2:SUITE 342
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5363
Practice Address - Country:US
Practice Address - Phone:630-916-0781
Practice Address - Fax:630-916-0786
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000528171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist