Organization
LA CLINICA SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EUGENE JAO DC (OWNER)
(312) 961-6611
Entity
Organization
Contact information
Practice address
4123 W FULLERTON AVE, CHICAGO, IL 60639-2105
(773) 278-9525
(708) 337-9135
Mailing address
PO BOX 4782, CHICAGO, IL 60680-4782
(773) 278-9525
(708) 337-9135
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
042620268
IL
Other
Enumeration date
12/16/2015
Last updated
12/16/2015
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