Provider Demographics
NPI:1851401087
Name:JEONG, WOOKEUN (DC)
Entity Type:Individual
Prefix:
First Name:WOOKEUN
Middle Name:
Last Name:JEONG
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 1:3459 SAINT JOHNS LN 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
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3455111N00000X
MDS03677111N00000X
VA0104556916111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
08703OtherBCBS
NC2459389Medicare PIN
U48893Medicare UPIN