MEDICARE: SUH HEALTH & PAIN CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1174345714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUH HEALTH & PAIN CLINIC LLC

Provider Business Mailing Address
First Line	:	1600 W GOLF RD
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-4004
Country	:	US
Telephone Number	:	847-364-2424
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 W GOLF RD
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-4004
Country	:	US
Telephone Number	:	847-364-2424
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DUCKIN SUH
Credential	:	DO
Telephone Number	:	847-364-2424

Provider Enumeration Date	:	10/25/2024
Last Update Date	:	10/25/2024

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