Provider Demographics
NPI:1104212851
Name:SANG'S SPINE AND REHAB CENTER, INC
Entity Type:Organization
Organization Name:SANG'S SPINE AND REHAB CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR D.C.
Authorized Official - Prefix:
Authorized Official - First Name:SANGWON
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-505-0105
Mailing Address - Street 1:9020 OLD GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1514
Mailing Address - Country:US
Mailing Address - Phone:703-505-0105
Mailing Address - Fax:240-223-2502
Practice Address - Street 1:9192 RED BRANCH RD STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2082
Practice Address - Country:US
Practice Address - Phone:410-418-9000
Practice Address - Fax:443-914-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty