Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038012148 | IL |
N | 111NS0005X | Chiropractic Sports Physician | 038012148 | IL |
NPI | 1093088924 |
---|---|
Provider Name | Dr. Emery Chen |
First Address | Brookfield, IL 60513-1286 |
Second Address | Brookfield, IL 60513-1286 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2012 |
Last Update Date | 23/02/2012 |