Provider Demographics
NPI:1407508971
Name:CHOO, KEVIN SAM (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:SAM
Last Name:CHOO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:214 W WACKERLY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2795
Mailing Address - Country:US
Mailing Address - Phone:989-837-5998
Mailing Address - Fax:989-835-9632
Practice Address - Street 1:214 W WACKERLY ST STE 100
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2795
Practice Address - Country:US
Practice Address - Phone:989-837-5998
Practice Address - Fax:989-835-9632
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI2301401181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor