Provider Demographics
NPI:1063744597
Name:CTL CHIROPRACTIC CLINIC LLC
Entity type:Organization
Organization Name:CTL CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HYUNGJIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-767-7490
Mailing Address - Street 1:213 N. BROAD ST. STE 6
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-2443
Mailing Address - Country:US
Mailing Address - Phone:215-767-7490
Mailing Address - Fax:267-263-2994
Practice Address - Street 1:213 N BROAD ST STE 6
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2443
Practice Address - Country:US
Practice Address - Phone:215-767-7490
Practice Address - Fax:267-263-2994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009954111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty