Provider Demographics
NPI:1669536579
Name:J CHUNG MORITA CHIROPRACTIC INC.
Entity type:Organization
Organization Name:J CHUNG MORITA CHIROPRACTIC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG MORITA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:909-860-1661
Mailing Address - Street 1:9015 EMPEROR AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775-2065
Mailing Address - Country:US
Mailing Address - Phone:626-309-7505
Mailing Address - Fax:
Practice Address - Street 1:1241 GRAND AVE
Practice Address - Street 2:SUITE C
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4447
Practice Address - Country:US
Practice Address - Phone:909-860-1661
Practice Address - Fax:909-860-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 28353111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC28353BMedicare ID - Type Unspecified
CAWDC28353AMedicare ID - Type Unspecified
CAW20364Medicare PIN
CAU99601Medicare UPIN