Provider Demographics
NPI:1396018271
Name:EOH PROFESSIONAL CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:EOH PROFESSIONAL CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAYOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:EOH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-258-8840
Mailing Address - Street 1:613 JASMINE PARKE DR APT 4
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-3496
Mailing Address - Country:US
Mailing Address - Phone:951-258-8840
Mailing Address - Fax:661-324-8349
Practice Address - Street 1:2920 F ST STE C5
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1829
Practice Address - Country:US
Practice Address - Phone:661-324-8348
Practice Address - Fax:661-324-8349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28688111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty