Provider Demographics
NPI:1215138094
Name:SONG, CHRISTIAN YOON (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:YOON
Last Name:SONG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:YOON
Other - Middle Name:SOO
Other - Last Name:SONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:8 GOLF CTR
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-4910
Mailing Address - Country:US
Mailing Address - Phone:847-755-0400
Mailing Address - Fax:847-755-0414
Practice Address - Street 1:8 GOLF CTR
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-4910
Practice Address - Country:US
Practice Address - Phone:847-755-0400
Practice Address - Fax:847-755-0414
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623415OtherBC BS PPO
ILU78011Medicare UPIN