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General NPI Number Information
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NPI Number | 1730453606
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Entity Type | Organization
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Legal Business Name | SPINE SOLUTION CHUNG CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 02/23/2012
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Last Update Date | 07/21/2015
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Provider Practice Location Address
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Address Line | 2970 W OLYMPIC BLVD # 303
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City | LOS ANGELES
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State | CA
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Zip | 90006-2518
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Country | US
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Telephone | 213-388-4030
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Fax | 213-388-4034
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Provider Business Mailing Address
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Address Line | 2970 W OLYMPIC BLVD # 303
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City | LOS ANGELES
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State | CA
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Zip | 90006-2518
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Country | US
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Telephone | 213-388-4030
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Fax | 213-388-4034
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YONG JAE CHUNG
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Credential | D.C.
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Telephone | 213-388-4030
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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 | DC-31391
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License Number State | CA
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