Provider Demographics
NPI:1417587460
Name:LIM, JONGCHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JONGCHAN
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9902 POTRANCO RD STE 119
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-9611
Mailing Address - Country:US
Mailing Address - Phone:210-960-9000
Mailing Address - Fax:
Practice Address - Street 1:9902 POTRANCO RD STE 119
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-9611
Practice Address - Country:US
Practice Address - Phone:210-960-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor