Provider Demographics
NPI:1376852251
Name:CHUNG, CHANG CHO (DC)
Entity Type:Individual
Prefix:
First Name:CHANG CHO
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:C
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:24578 SUNNYMEAD BL.
Mailing Address - Street 2:# C/D
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553
Mailing Address - Country:US
Mailing Address - Phone:951-924-5770
Mailing Address - Fax:951-485-8523
Practice Address - Street 1:24578 SUNNYMEAD BL.
Practice Address - Street 2:# C/D
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553
Practice Address - Country:US
Practice Address - Phone:951-924-5770
Practice Address - Fax:951-485-8523
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor