Provider Demographics
NPI:1356661615
Name:CHUNG, JONATHAN JANMIN (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:JANMIN
Last Name:CHUNG
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 1:8808 PALOMINO DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-1119
Mailing Address - Country:US
Mailing Address - Phone:954-649-4507
Mailing Address - Fax:
Practice Address - Street 1:8808 PALOMINO DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-1119
Practice Address - Country:US
Practice Address - Phone:954-649-4507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10016111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor