Provider Demographics
NPI:1518938364
Name:YEOUM, TAESUN (DC)
Entity Type:Individual
Prefix:DR
First Name:TAESUN
Middle Name:
Last Name:YEOUM
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 1:1600 N BETHLEHEM PIKE
Mailing Address - Street 2:SOUTH BUILDING SUITE S110
Mailing Address - City:LOWER GWYNEDD
Mailing Address - State:PA
Mailing Address - Zip Code:19002-1427
Mailing Address - Country:US
Mailing Address - Phone:215-628-0304
Mailing Address - Fax:215-628-0306
Practice Address - Street 1:1600 N BETHLEHEM PIKE
Practice Address - Street 2:SOUTH BUILDING S110
Practice Address - City:LOWER GWYNEDD
Practice Address - State:PA
Practice Address - Zip Code:19002-1427
Practice Address - Country:US
Practice Address - Phone:215-628-0304
Practice Address - Fax:215-628-0306
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008861111N00000X
NJ38MC00670700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2349132000OtherIBC
PA7827654OtherAETNA