Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 038010090 | IL |
NPI | 1376798934 |
---|---|
Provider Name | Dr. Willes Ko |
First Address | Wheeling, IL 60090 |
Second Address | Wheeling, IL 60090 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2008 |
Last Update Date | 06/07/2012 |