Provider Demographics
NPI:1558563502
Name:JO, PETER YONGHUN (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:YONGHUN
Last Name:JO
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 1:3840 LONGSTREET CT
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1709
Mailing Address - Country:US
Mailing Address - Phone:571-337-7477
Mailing Address - Fax:
Practice Address - Street 1:3840 LONGSTREET CT
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-1709
Practice Address - Country:US
Practice Address - Phone:571-337-7477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034663111NN0400X
VA0104556753111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology