Provider Demographics
NPI:1346393220
Name:PARK, INHYON (DC, LAC)
Entity Type:Individual
Prefix:
First Name:INHYON
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 LINWOOD PLZ STE 308
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3704
Mailing Address - Country:US
Mailing Address - Phone:201-461-9333
Mailing Address - Fax:201-461-0851
Practice Address - Street 1:158 LINWOOD PLZ STE 308
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-3704
Practice Address - Country:US
Practice Address - Phone:201-461-9333
Practice Address - Fax:201-461-0851
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00008500171100000X
NJMC04140111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ33492Medicare UPIN
NJPA058320Medicare ID - Type Unspecified