Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 038-009417 | IL |
NPI | 1164599775 |
---|---|
Provider Name | Dr. Koren Jean Duhr |
First Address | Lake In The Hills, IL 60156-6703 |
Second Address | Crystal Lake, IL 60014-8059 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05632158 | BLUE CROSS BLUE SHIELD (01) | IL |