Provider Demographics
NPI:1376615989
Name:HOLM, SUJIN
Entity Type:Individual
Prefix:
First Name:SUJIN
Middle Name:
Last Name:HOLM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W HIGGINS RD
Mailing Address - Street 2:SUITE 810
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60195-5220
Mailing Address - Country:US
Mailing Address - Phone:847-884-9515
Mailing Address - Fax:847-884-9524
Practice Address - Street 1:2500 W HIGGINS RD
Practice Address - Street 2:SUITE 810
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-7220
Practice Address - Country:US
Practice Address - Phone:847-884-9515
Practice Address - Fax:847-884-9524
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009866111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU93703Medicare UPIN
IL204482Medicare ID - Type Unspecified