Provider Demographics
NPI:1336361815
Name:SBC CHIROPRACTIC CLINIC, INC
Entity Type:Organization
Organization Name:SBC CHIROPRACTIC CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BYUNG
Authorized Official - Middle Name:KWAN
Authorized Official - Last Name:CHUN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-541-3456
Mailing Address - Street 1:325 N MILWAUKEE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-3071
Mailing Address - Country:US
Mailing Address - Phone:847-541-3456
Mailing Address - Fax:847-541-3656
Practice Address - Street 1:325 N MILWAUKEE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-3071
Practice Address - Country:US
Practice Address - Phone:847-541-3456
Practice Address - Fax:847-541-3656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635320OtherBLUECROSS BLUE SHIELD
V08218Medicare UPIN
IL01635320OtherBLUECROSS BLUE SHIELD