Healthcare Provider Details

I. General information

NPI: 1861734790
Provider Name (Legal Business Name): E.Y. SONG CHIROPRACTIC, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 W COMMONWEALTH AVE
FULLERTON CA
92833-2724
US

IV. Provider business mailing address

1324 W COMMONWEALTH AVE
FULLERTON CA
92833-2724
US

V. Phone/Fax

Practice location:
  • Phone: 714-446-0200
  • Fax: 714-451-8974
Mailing address:
  • Phone: 714-446-0200
  • Fax: 714-451-8974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC32478
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC14892
License Number StateCA

VIII. Authorized Official

Name: DR. EUN YOUNG SONG
Title or Position: PRESIDENT
Credential: DC
Phone: 714-446-0200