Provider Demographics
NPI:1093068520
Name:KWON, HYUKJUNG (DC)
Entity Type:Individual
Prefix:
First Name:HYUKJUNG
Middle Name:
Last Name:KWON
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 1:801 S GAMMON RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1303
Mailing Address - Country:US
Mailing Address - Phone:608-274-5966
Mailing Address - Fax:608-274-5965
Practice Address - Street 1:801 S GAMMON RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1303
Practice Address - Country:US
Practice Address - Phone:608-274-5966
Practice Address - Fax:608-274-5965
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4856-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor