Provider Demographics
NPI:1821286394
Name:KAO, TOM M (DC)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:M
Last Name:KAO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:TOM
Other - Middle Name:M
Other - Last Name:KAO-CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1104 4TH ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:IL
Mailing Address - Zip Code:61252-1718
Mailing Address - Country:US
Mailing Address - Phone:815-589-4616
Mailing Address - Fax:
Practice Address - Street 1:1104 4TH ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:IL
Practice Address - Zip Code:61252-1718
Practice Address - Country:US
Practice Address - Phone:815-589-4616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007086111N00000X
IAA05807111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1119974Medicaid
IL350043559OtherRAILROAD PROVIDER NUMBER
IL38007086Medicaid
IL38007086Medicaid
IA21354Medicare UPIN