MEDICARE: DR. BORYEONG 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	038.013063	IL

General Provider Information

NPI Number	:	1023543154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BORYEONG KIM D.C

Provider Business Mailing Address
First Line	:	2605 S INDIANA AVE UNIT 2106
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2877
Country	:	US
Telephone Number	:	630-561-5001
Fax Number	:

Provider Business Practice Location Address
First Line	:	3405 S HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-6707
Country	:	US
Telephone Number	:	630-561-5001
Fax Number	:

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

Provider Enumeration Date	:	04/26/2017
Last Update Date	:	04/12/2022

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