MEDICARE: IHN KIM D.C.

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	038012220	IL

General Provider Information

NPI Number	:	1689066169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IHN KIM D.C.

Provider Business Mailing Address
First Line	:	1052 S ELMHURST RD
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-4240
Country	:	US
Telephone Number	:	847-439-9100
Fax Number	:	847-439-9105

Provider Business Practice Location Address
First Line	:	1052 S ELMHURST RD
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-4240
Country	:	US
Telephone Number	:	847-439-9100
Fax Number	:	847-439-9105

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2015
Last Update Date	:	02/20/2015

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