MEDICARE: SPINE SOLUTION CHUNG CHIROPRACTIC, INC.

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	111N00000X	Chiropractor	DC-31391	CA

General Provider Information

NPI Number	:	1730453606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINE SOLUTION CHUNG CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	2970 W OLYMPIC BLVD # 303
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2518
Country	:	US
Telephone Number	:	213-388-4030
Fax Number	:	213-388-4034

Provider Business Practice Location Address
First Line	:	2970 W OLYMPIC BLVD # 303
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2518
Country	:	US
Telephone Number	:	213-388-4030
Fax Number	:	213-388-4034

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. YONG JAE CHUNG
Credential	:	D.C.
Telephone Number	:	213-388-4030

Provider Enumeration Date	:	02/23/2012
Last Update Date	:	07/21/2015

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