Provider Demographics
NPI:1346604501
Name:MEDCOA CLINIC, LTD.
Entity Type:Organization
Organization Name:MEDCOA CLINIC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:JIN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-648-4101
Mailing Address - Street 1:990 GRAND CANYON PKWY
Mailing Address - Street 2:SUITE 114
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1739
Mailing Address - Country:US
Mailing Address - Phone:847-648-4101
Mailing Address - Fax:847-744-5128
Practice Address - Street 1:990 GRAND CANYON PKWY
Practice Address - Street 2:SUITE 114
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1739
Practice Address - Country:US
Practice Address - Phone:847-648-4101
Practice Address - Fax:847-744-5128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012896111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty