Healthcare Provider Details

I. General information

NPI: 1164063269
Provider Name (Legal Business Name): LJ MEDICATION, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 WASHINGTON ST
WAUKEGAN IL
60085-5301
US

IV. Provider business mailing address

PO BOX 4782
CHICAGO IL
60680-4782
US

V. Phone/Fax

Practice location:
  • Phone: 773-278-9525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EUGENE MARIO JAO
Title or Position: PRESIDENT
Credential: DC
Phone: 773-278-9525