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General NPI Number Information
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NPI Number | 1114272010
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Entity Type | Organization
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Legal Business Name | KBJ CHIROPRACTIC PC
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 07/17/2012
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Provider Practice Location Address
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Address Line | 1736 ESSINGTON RD
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City | JOLIET
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State | IL
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Zip | 60435-1600
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Country | US
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Telephone | 815-577-8527
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Fax |
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Provider Business Mailing Address
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Address Line | 1736 ESSINGTON RD
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City | JOLIET
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State | IL
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Zip | 60435-1600
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Country | US
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Telephone | 815-577-8527
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRYON COKER
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Credential | DC
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Telephone | 815-577-8527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 038009082
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License Number State | IL
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