Provider Demographics
NPI:1639242647
Name:CHUNG, SUSAN L (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:CHUNG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:L
Other - Last Name:CHUNG-WAGGONER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:7000 NW EXPRESSWAY ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-3514
Mailing Address - Country:US
Mailing Address - Phone:405-773-1113
Mailing Address - Fax:405-773-1114
Practice Address - Street 1:7000 NW EXPRESSWAY ST
Practice Address - Street 2:SUITE H
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-3514
Practice Address - Country:US
Practice Address - Phone:405-773-1113
Practice Address - Fax:405-773-1114
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3139111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU46857Medicare UPIN