Provider Demographics
NPI:1730206095
Name:MCKIM FAMILY CHIROPRACTIC SC
Entity type:Organization
Organization Name:MCKIM FAMILY CHIROPRACTIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MCKIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-477-7718
Mailing Address - Street 1:820 E TERRA COTTA AVE
Mailing Address - Street 2:STE 141
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3649
Mailing Address - Country:US
Mailing Address - Phone:815-477-7718
Mailing Address - Fax:815-477-7121
Practice Address - Street 1:820 E TERRA COTTA AVE
Practice Address - Street 2:STE 141
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3649
Practice Address - Country:US
Practice Address - Phone:815-477-7718
Practice Address - Fax:815-477-7121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211959Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER