Healthcare Provider Details

I. General information

NPI: 1336143072
Provider Name (Legal Business Name): DAVID S JUNG D.C., L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25566 LORAIN RD
NORTH OLMSTED OH
44070-3322
US

IV. Provider business mailing address

25566 LORAIN RD
NORTH OLMSTED OH
44070-3322
US

V. Phone/Fax

Practice location:
  • Phone: 440-777-7730
  • Fax: 440-777-7727
Mailing address:
  • Phone: 440-777-7730
  • Fax: 440-777-7727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3637
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number65.000128
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: