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General NPI Number Information
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NPI Number | 1699032813
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Entity Type | Organization
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Legal Business Name | BALANCED BODY INTEGRATED WELLNESS S.C.
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Dates
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Enumeration Date | 04/12/2012
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Last Update Date | 04/12/2012
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Provider Practice Location Address
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Address Line | 2569 W FULLERTON AVENUE
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City | CHICAGO
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State | IL
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Zip | 60647-3147
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Country | US
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Telephone | 773-252-9740
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Fax | 773-252-9746
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Provider Business Mailing Address
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Address Line | 2569 W FULLERTON AVENUE
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City | CHICAGO
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State | IL
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Zip | 60647-3147
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Country | US
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Telephone | 773-252-9740
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Fax | 773-252-9746
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Authorized Official
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Title or Position | OWNER / CHIROPRACTOR
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Name | JEE HOON KIM
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Credential | D.C.
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Telephone | 773-252-9740
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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 | 038.008066
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License Number State | IL
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