Provider Demographics
NPI:1164480067
Name:SONG, HOJOON (DC)
Entity Type:Individual
Prefix:DR
First Name:HOJOON
Middle Name:
Last Name:SONG
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 1:2301 RAMA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-6237
Mailing Address - Country:US
Mailing Address - Phone:704-566-6132
Mailing Address - Fax:704-837-7353
Practice Address - Street 1:2301 RAMA RD
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-6237
Practice Address - Country:US
Practice Address - Phone:704-566-6132
Practice Address - Fax:704-837-7353
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3236111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085UMMedicaid
NC89085UMMedicaid
NCV00146Medicare UPIN