Healthcare Provider Details

I. General information

NPI: 1578762324
Provider Name (Legal Business Name): MICHAEL E JUNG D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 FLETCHER DR 304
ELGIN IL
60123-4703
US

IV. Provider business mailing address

750 FLETCHER DR 304
ELGIN IL
60123-4703
US

V. Phone/Fax

Practice location:
  • Phone: 847-888-3131
  • Fax: 847-888-3359
Mailing address:
  • Phone: 847-888-3131
  • Fax: 847-888-3359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-006180
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: