Provider Demographics
NPI:1457616476
Name:CHEN, JIN KONG (DC)
Entity Type:Individual
Prefix:
First Name:JIN
Middle Name:KONG
Last Name:CHEN
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 1:80 BOWERY
Mailing Address - Street 2:RM 403
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4614
Mailing Address - Country:US
Mailing Address - Phone:917-353-9973
Mailing Address - Fax:212-966-9797
Practice Address - Street 1:80 BOWERY
Practice Address - Street 2:RM 403
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4614
Practice Address - Country:US
Practice Address - Phone:212-966-9899
Practice Address - Fax:212-966-9797
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012209111N00000X
NY0122111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor