Provider Demographics
NPI:1578581807
Name:KIM, JOSEPH TAEYOO (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:TAEYOO
Last Name:KIM
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 1:1710 S NEIL ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7276
Mailing Address - Country:US
Mailing Address - Phone:217-614-4044
Mailing Address - Fax:
Practice Address - Street 1:1710 S NEIL ST STE 2
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7276
Practice Address - Country:US
Practice Address - Phone:217-614-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28249111N00000X
IL038012942111N00000X
TX10630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor