Provider Demographics
NPI:1295052983
Name:SONG, YONG HYON (DC)
Entity type:Individual
Prefix:DR
First Name:YONG
Middle Name:HYON
Last Name:SONG
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 1:22540 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1841
Mailing Address - Country:US
Mailing Address - Phone:248-399-9355
Mailing Address - Fax:248-399-8644
Practice Address - Street 1:22540 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1841
Practice Address - Country:US
Practice Address - Phone:248-399-9355
Practice Address - Fax:248-399-8644
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008320111N00000X
MI2301009012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACHIR008320OtherSTATE LISCENSE
MI2301009012OtherSTATE LISCENSING