Provider Demographics
NPI:1396826673
Name:HONG, CAROL (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:HONG
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:DR
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:CHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC, LAC
Mailing Address - Street 1:21127 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4615
Mailing Address - Country:US
Mailing Address - Phone:310-316-0066
Mailing Address - Fax:
Practice Address - Street 1:21127 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4615
Practice Address - Country:US
Practice Address - Phone:310-316-0066
Practice Address - Fax:424-652-2264
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29197111N00000X
CAAC 10606171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18456Medicare ID - Type UnspecifiedMEDICARE GROUP ID #
CAV03855Medicare UPIN
CAWDC29197AMedicare ID - Type UnspecifiedMEDICARE PPIN