Provider Demographics
NPI:1508019498
Name:JUNG CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:JUNG CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-817-9500
Mailing Address - Street 1:520 N BROOKHURST ST
Mailing Address - Street 2:102
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-5227
Mailing Address - Country:US
Mailing Address - Phone:714-817-9500
Mailing Address - Fax:714-817-9555
Practice Address - Street 1:520 N BROOKHURST ST
Practice Address - Street 2:102
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5227
Practice Address - Country:US
Practice Address - Phone:714-817-9500
Practice Address - Fax:714-817-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25977111N00000X
CAPT34512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19471Medicare PIN