Provider Demographics
NPI:1326383670
Name:PETER JUNG CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:PETER JUNG CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-817-7444
Mailing Address - Street 1:520 N BROOKHURST ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-5207
Mailing Address - Country:US
Mailing Address - Phone:714-817-7444
Mailing Address - Fax:888-234-2363
Practice Address - Street 1:520 N BROOKHURST ST STE 102
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5207
Practice Address - Country:US
Practice Address - Phone:714-817-7444
Practice Address - Fax:888-234-2363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25977111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty