Provider Demographics
NPI:1073090387
Name:PRIMECARE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:PRIMECARE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIN WOO
Authorized Official - Middle Name:
Authorized Official - Last Name:JONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:940-279-5012
Mailing Address - Street 1:10708 MARFA WAY
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-6707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8668 JOHN HICKMAN PKWY STE 302
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-8181
Practice Address - Country:US
Practice Address - Phone:940-279-5012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13530111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1457732687OtherCHIROPRACTIC