Provider Demographics
NPI:1548905193
Name:HWANGBO, TAELYONG LIO (DC)
Entity type:Individual
Prefix:
First Name:TAELYONG
Middle Name:LIO
Last Name:HWANGBO
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 1:3513 BELRIDGE LN SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-1629
Mailing Address - Country:US
Mailing Address - Phone:334-379-7191
Mailing Address - Fax:
Practice Address - Street 1:3513 BELRIDGE LN SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-1629
Practice Address - Country:US
Practice Address - Phone:334-379-7191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor