Provider Demographics
NPI:1093469702
Name:KALIN, JONATHAN ANDREW (LAC, DACM)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ANDREW
Last Name:KALIN
Suffix:
Gender:M
Credentials:LAC, DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 S MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2601
Mailing Address - Country:US
Mailing Address - Phone:312-216-2420
Mailing Address - Fax:312-216-2421
Practice Address - Street 1:1335 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2601
Practice Address - Country:US
Practice Address - Phone:312-216-2420
Practice Address - Fax:312-216-2421
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001592171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist