Provider Demographics
NPI:1023851573
Name:PARK, IN-MOON IRIS (DC)
Entity type:Individual
Prefix:
First Name:IN-MOON
Middle Name:IRIS
Last Name:PARK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:IRIS
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:40 SAINT MARK RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-5233
Mailing Address - Country:US
Mailing Address - Phone:864-283-0600
Mailing Address - Fax:
Practice Address - Street 1:40 SAINT MARK RD
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-5233
Practice Address - Country:US
Practice Address - Phone:864-283-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC5052111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor