Provider Demographics
NPI:1609905363
Name:CHUNG, MICHAEL TRI (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TRI
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 1:1205 CHESTNUT ST
Mailing Address - Street 2:#B
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4219
Mailing Address - Country:US
Mailing Address - Phone:510-847-1340
Mailing Address - Fax:
Practice Address - Street 1:1205 CHESTNUT ST
Practice Address - Street 2:#B
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4219
Practice Address - Country:US
Practice Address - Phone:510-847-1340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor