MEDICARE: DR. HYUN CHARLIE JO D.C., AEMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC60812877	WA
2	111N00000X	Chiropractor	CH60435756	WA

General Provider Information

NPI Number	:	1063837995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HYUN CHARLIE JO D.C., AEMP

Provider Business Mailing Address
First Line	:	7404 EVERGREEN WAY STE A
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98203-5683
Country	:	US
Telephone Number	:	425-382-2188
Fax Number	:	888-741-1274

Provider Business Practice Location Address
First Line	:	7404 EVERGREEN WAY STE A
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98203
Country	:	US
Telephone Number	:	425-382-2188
Fax Number	:	888-741-1274

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2014
Last Update Date	:	11/05/2024

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