Provider Demographics
NPI:1659418572
Name:PARK, JOHN HO (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HO
Last Name:PARK
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 1:15200 SHADY GROVE RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3218
Mailing Address - Country:US
Mailing Address - Phone:240-477-8719
Mailing Address - Fax:
Practice Address - Street 1:15200 SHADY GROVE RD
Practice Address - Street 2:SUITE 211
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3218
Practice Address - Country:US
Practice Address - Phone:240-477-8719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02093111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG01528P01Medicare ID - Type UnspecifiedPROVIDER NUMBER