Provider Demographics
NPI:1023061280
Name:CHUN, EDWARD SOOJIN (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:SOOJIN
Last Name:CHUN
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 1:1207 S MATTIS AVE
Mailing Address - Street 2:STE2
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-4861
Mailing Address - Country:US
Mailing Address - Phone:217-355-5922
Mailing Address - Fax:217-355-5925
Practice Address - Street 1:1207 S MATTIS AVE
Practice Address - Street 2:STE2
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-4861
Practice Address - Country:US
Practice Address - Phone:217-355-5922
Practice Address - Fax:217-355-5925
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010471111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK23534Medicare ID - Type UnspecifiedWPS MEDICARE ID NUMBER