Provider Demographics
NPI:1679872717
Name:ZHAO, IRIS (DC, LAC)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:ZHAO
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 S MICHIGAN AVE
Mailing Address - Street 2:UNIT C1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-5522
Mailing Address - Country:US
Mailing Address - Phone:312-949-1289
Mailing Address - Fax:312-949-1292
Practice Address - Street 1:1845 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-5522
Practice Address - Country:US
Practice Address - Phone:312-949-1289
Practice Address - Fax:312-949-1292
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011587111N00000X
IL198001004171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist