Healthcare Provider Details

I. General information

NPI: 1508019498
Provider Name (Legal Business Name): JUNG CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N BROOKHURST ST 102
ANAHEIM CA
92801-5227
US

IV. Provider business mailing address

520 N BROOKHURST ST 102
ANAHEIM CA
92801-5227
US

V. Phone/Fax

Practice location:
  • Phone: 714-817-9500
  • Fax: 714-817-9555
Mailing address:
  • Phone: 714-817-9500
  • Fax: 714-817-9555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC25977
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT34512
License Number StateCA

VIII. Authorized Official

Name: PETER S JUNG
Title or Position: PRESIDENT
Credential: D.C.
Phone: 714-817-9500