Provider Demographics
NPI:1457197519
Name:CHOW, WAN LUNG (DC)
Entity type:Individual
Prefix:DR
First Name:WAN LUNG
Middle Name:
Last Name:CHOW
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 1:3107 LENOX PARK CIR NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-5357
Mailing Address - Country:US
Mailing Address - Phone:678-908-9166
Mailing Address - Fax:
Practice Address - Street 1:3755 CARMIA DR SW STE 440
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-6253
Practice Address - Country:US
Practice Address - Phone:470-275-2984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR011218111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor