Provider Demographics
NPI:1770838492
Name:JEONG WELLNESS CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:JEONG WELLNESS CHIROPRACTIC, INC.
Other - Org Name:JEONG WELLNESS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WOOKEUN
Authorized Official - Middle Name:
Authorized Official - Last Name:JEONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-461-5695
Mailing Address - Street 1:3459 ST. JOHNS LANE STE. 2
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-4025
Mailing Address - Country:US
Mailing Address - Phone:410-461-5695
Mailing Address - Fax:410-461-5496
Practice Address - Street 1:3459 SAINT JOHNS LN STE 2
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-4025
Practice Address - Country:US
Practice Address - Phone:410-461-5695
Practice Address - Fax:410-461-5496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03677111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty