=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639309677
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YOUNG CHIROPRACTIC P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2009
-----------------------------------------------------
Last Update Date | 07/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 385 SYLVAN AVE #23
-----------------------------------------------------
City | ENGLEWOOD CLIFFS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07632-2726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-568-9111
-----------------------------------------------------
Fax | 201-568-9116
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 385 SYLVAN AVE #23
-----------------------------------------------------
City | ENGLEWOOD CLIFFS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07632-2726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-568-9111
-----------------------------------------------------
Fax | 201-568-9116
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RYEJIN J HWANG
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 201-568-9111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 38MC00656500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------