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NPI Code Detail

MEDICARE: PETERSON CHIROPRACTIC CLINIC SC

MEDICARE: PETERSON CHIROPRACTIC CLINIC SC
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
1111N00000XChiropractor038005934IL

General Provider Information

NPI Number : 1477763183
Entity Type Code : Organization
Provider Name (Legal Business Name) : PETERSON CHIROPRACTIC CLINIC SC
Provider Business Mailing Address
First Line : 3044 W PETERSON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60659-3729
Country : US
Telephone Number : 773-743-0228
Fax Number : 773-743-0425
Provider Business Practice Location Address
First Line : 3044 W PETERSON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60659-3729
Country : US
Telephone Number : 773-743-0228
Fax Number : 773-743-0425
Authorized Official
Title or Position : PRESIDENT
Name : DR. HAN K CHO
Credential : D.C.
Telephone Number : 773-743-0228
Provider Enumeration Date : 05/23/2007
Last Update Date : 05/30/2013

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Directions to “PETERSON CHIROPRACTIC CLINIC SC ” Practice Location

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