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General NPI Number Information
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NPI Number | 1407137565
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Entity Type | Organization
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Legal Business Name | YONSEI PAIN CLINIC
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Dates
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Enumeration Date | 09/02/2011
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Last Update Date | 10/24/2011
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Provider Practice Location Address
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Address Line | 4257 N MILWAUKEE AVE
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City | CHICAGO
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State | IL
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Zip | 60641-1642
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Country | US
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Telephone | 309-235-7244
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Fax |
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Provider Business Mailing Address
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Address Line | 3604 74TH ST
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City | MOLINE
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State | IL
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Zip | 61265-8015
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Country | US
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Telephone | 309-235-7244
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | YOUNG KI SON
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Credential |
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Telephone | 309-235-7244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038011490
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License Number State | IL
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