Healthcare Provider Details

I. General information

NPI: 1922259795
Provider Name (Legal Business Name): JEUNG CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23341 GOLDEN SPRINGS DR SUITE 210
DIAMOND BAR CA
91765-2058
US

IV. Provider business mailing address

23341 GOLDEN SPRINGS DR SUITE 210
DIAMOND BAR CA
91765-2058
US

V. Phone/Fax

Practice location:
  • Phone: 909-860-4307
  • Fax: 909-860-1192
Mailing address:
  • Phone: 909-860-4307
  • Fax: 909-860-1192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC30173
License Number StateCA

VIII. Authorized Official

Name: JONG-EUL JEUNG
Title or Position: PRESIDENT
Credential: D.C.
Phone: 909-860-4307