Provider Demographics
NPI:1912920703
Name:CHO, MI-KYONG (DC)
Entity Type:Individual
Prefix:DR
First Name:MI-KYONG
Middle Name:
Last Name:CHO
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 1:12798 RANCHO PENASQUITOS BLVD
Mailing Address - Street 2:SUITE # J
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2950
Mailing Address - Country:US
Mailing Address - Phone:858-484-4242
Mailing Address - Fax:858-484-4002
Practice Address - Street 1:12798 RANCHO PENASQUITOS BLVD
Practice Address - Street 2:SUITE # J
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2950
Practice Address - Country:US
Practice Address - Phone:858-484-4242
Practice Address - Fax:858-484-4002
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC29362Medicare ID - Type UnspecifiedCHIROPRACTIC SERVICE