Provider Demographics
NPI:1053781922
Name:ADIOS CHIROPRACTIC, PC
Entity type:Organization
Organization Name:ADIOS CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-363-0233
Mailing Address - Street 1:2500 LEMOINE AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6205
Mailing Address - Country:US
Mailing Address - Phone:201-363-0233
Mailing Address - Fax:201-363-0266
Practice Address - Street 1:2500 LEMOINE AVE STE 303
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6205
Practice Address - Country:US
Practice Address - Phone:201-363-0233
Practice Address - Fax:201-363-0266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-04
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00723200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty