Provider Demographics
NPI:1922259795
Name:JEUNG CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:JEUNG CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONG-EUL
Authorized Official - Middle Name:
Authorized Official - Last Name:JEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:909-860-4307
Mailing Address - Street 1:23341 GOLDEN SPRINGS DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-2058
Mailing Address - Country:US
Mailing Address - Phone:909-860-4307
Mailing Address - Fax:909-860-1192
Practice Address - Street 1:23341 GOLDEN SPRINGS DR
Practice Address - Street 2:SUITE 210
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-2058
Practice Address - Country:US
Practice Address - Phone:909-860-4307
Practice Address - Fax:909-860-1192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC30173OtherCALIFORNIA CHIROPRACTIC BOARD