Provider Demographics
NPI:1083722235
Name:CHOI, CHANGRYOL (ATC)
Entity Type:Individual
Prefix:MR
First Name:CHANGRYOL
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 JOHNSON ST
Mailing Address - Street 2:APT A-5
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-1470
Mailing Address - Country:US
Mailing Address - Phone:800-233-3550
Mailing Address - Fax:
Practice Address - Street 1:700 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-1454
Practice Address - Country:US
Practice Address - Phone:800-233-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist