Provider Demographics
NPI:1326174806
Name:SONG, GREG YOUNG (DC)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:YOUNG
Last Name:SONG
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:32545 GOLDEN LANTERN ST
Mailing Address - Street 2:B279
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3251
Mailing Address - Country:US
Mailing Address - Phone:949-289-2543
Mailing Address - Fax:800-695-3418
Practice Address - Street 1:1063 LOWER MAIN ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2038
Practice Address - Country:US
Practice Address - Phone:949-289-2543
Practice Address - Fax:800-695-3418
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HI00315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor