Provider Demographics
NPI:1760563332
Name:PARK, HEE NAM (DC)
Entity Type:Individual
Prefix:DR
First Name:HEE
Middle Name:NAM
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 1:85 RARITAN AVE
Mailing Address - Street 2:SUITE 430
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2439
Mailing Address - Country:US
Mailing Address - Phone:732-342-7575
Mailing Address - Fax:732-342-7355
Practice Address - Street 1:85 RARITAN AVE
Practice Address - Street 2:SUITE 430
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2439
Practice Address - Country:US
Practice Address - Phone:732-342-7575
Practice Address - Fax:732-342-7355
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00650300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor