Provider Demographics
NPI:1730433962
Name:PARK, CARLIN C (LAC)
Entity type:Individual
Prefix:
First Name:CARLIN
Middle Name:C
Last Name:PARK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:21 KRISTIN DR
Mailing Address - Street 2:UNIT 1210
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60195-3398
Mailing Address - Country:US
Mailing Address - Phone:773-895-3908
Mailing Address - Fax:
Practice Address - Street 1:21 KRISTIN DR
Practice Address - Street 2:UNIT 1210
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60195-3398
Practice Address - Country:US
Practice Address - Phone:773-895-3908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001107171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist