Provider Demographics
NPI:1508451147
Name:JEON, TAEJIN (DC)
Entity Type:Individual
Prefix:DR
First Name:TAEJIN
Middle Name:
Last Name:JEON
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 1:2111 S WABASH AVE APT 1402
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1792
Mailing Address - Country:US
Mailing Address - Phone:515-468-8928
Mailing Address - Fax:
Practice Address - Street 1:2052 N CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4505
Practice Address - Country:US
Practice Address - Phone:773-281-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor