Provider Demographics
NPI:1104174499
Name:KIM CHIROPRACTIC AND REHAB P.C.
Entity type:Organization
Organization Name:KIM CHIROPRACTIC AND REHAB P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YONG
Authorized Official - Middle Name:KYU
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:469-685-8918
Mailing Address - Street 1:5453 N MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3104
Mailing Address - Country:US
Mailing Address - Phone:469-685-8918
Mailing Address - Fax:972-550-6013
Practice Address - Street 1:5453 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-3104
Practice Address - Country:US
Practice Address - Phone:469-685-8918
Practice Address - Fax:972-550-6013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1356535124OtherINDIVIDUAL NPI