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General NPI Number Information
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NPI Number | 1174133490
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Entity Type | Organization
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Legal Business Name | YJP SPINE CENTER LLC
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Dates
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Enumeration Date | 08/01/2020
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 4920 W THUNDERBIRD RD STE 112
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City | GLENDALE
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State | AZ
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Zip | 85306-4906
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Country | US
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Telephone | 623-487-3444
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Fax |
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Provider Business Mailing Address
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Address Line | 4920 W THUNDERBIRD RD STE 112
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City | GLENDALE
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State | AZ
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Zip | 85306-4906
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Country | US
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Telephone | 623-487-3444
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YUNJAE PARK
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Credential |
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Telephone | 224-628-0733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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