Provider Demographics
NPI:1437220902
Name:CHUNG, DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
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 1:9820 N MILWAUKEE AVE
Mailing Address - Street 2:UNIT C & D
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-0000
Mailing Address - Country:US
Mailing Address - Phone:815-458-6597
Mailing Address - Fax:815-458-7934
Practice Address - Street 1:9820 N MILWAUKEE AVE
Practice Address - Street 2:UNIT C & D
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-0000
Practice Address - Country:US
Practice Address - Phone:815-458-6597
Practice Address - Fax:815-458-7934
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL623140Medicare ID - Type Unspecified