Provider Demographics
NPI:1437190709
Name:PARK, HANPHIL (DC)
Entity Type:Individual
Prefix:
First Name:HANPHIL
Middle Name:
Last Name:PARK
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 1:9820 MILWAUKEE AVE # C&D
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1805
Mailing Address - Country:US
Mailing Address - Phone:847-296-1004
Mailing Address - Fax:
Practice Address - Street 1:9820 MILWAUKEE AVE # C&D
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1805
Practice Address - Country:US
Practice Address - Phone:847-296-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010409111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor