Provider Demographics
NPI:1659455459
Name:PAK, JUA EUNJONE (DC)
Entity Type:Individual
Prefix:MRS
First Name:JUA
Middle Name:EUNJONE
Last Name:PAK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8325 HAVEN AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3894
Mailing Address - Country:US
Mailing Address - Phone:909-484-3899
Mailing Address - Fax:909-484-3898
Practice Address - Street 1:8325 HAVEN AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3894
Practice Address - Country:US
Practice Address - Phone:909-484-3899
Practice Address - Fax:909-484-3898
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25914111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0259140Medicare ID - Type UnspecifiedMEDICARE NUMBER