Provider Demographics
NPI:1003940131
Name:PARK, CHAN HO (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAN HO
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8815 S TACOMA WAY
Mailing Address - Street 2:#120
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4587
Mailing Address - Country:US
Mailing Address - Phone:253-582-1383
Mailing Address - Fax:253-682-2841
Practice Address - Street 1:8815 S TACOMA WAY
Practice Address - Street 2:#120
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4587
Practice Address - Country:US
Practice Address - Phone:253-582-1383
Practice Address - Fax:253-682-2841
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034522111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor