Provider Demographics
NPI:1093108482
Name:LUNG, JENNIFER (DC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LUNG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12339 WAKE UNION CHURCH RD STE 102
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4512
Mailing Address - Country:US
Mailing Address - Phone:919-245-7358
Mailing Address - Fax:919-263-1711
Practice Address - Street 1:12339 WAKE UNION CHURCH RD STE 102
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4512
Practice Address - Country:US
Practice Address - Phone:919-245-7358
Practice Address - Fax:919-263-1711
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4545111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4545OtherNORTH CAROLINA LICENSE NUMBER