Provider Demographics
NPI:1881769529
Name:DONG, JUN (DC)
Entity type:Individual
Prefix:
First Name:JUN
Middle Name:
Last Name:DONG
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 1:141 E 55TH ST
Mailing Address - Street 2:SUITE 5E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4030
Mailing Address - Country:US
Mailing Address - Phone:917-882-6826
Mailing Address - Fax:212-317-1968
Practice Address - Street 1:141 E 55TH ST
Practice Address - Street 2:SUITE 5E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4030
Practice Address - Country:US
Practice Address - Phone:917-882-6826
Practice Address - Fax:212-317-1968
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010333111N00000X
NJ38MC00601200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU90760Medicare UPIN
NYX5E991Medicare ID - Type UnspecifiedCHIROPRACTOR