Provider Demographics
NPI:1154337376
Name:CHO, ANTHONY JINEUN (DC)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JINEUN
Last Name:CHO
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 1:9896 GARDEN GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844
Mailing Address - Country:US
Mailing Address - Phone:714-636-3032
Mailing Address - Fax:714-636-3116
Practice Address - Street 1:9896 GARDEN GROVE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844
Practice Address - Country:US
Practice Address - Phone:714-636-3032
Practice Address - Fax:714-636-3116
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25963111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0259630Medicaid
CADC0259630OtherBLUE SHIELD
CADC0259630OtherBLUE SHIELD
U73409Medicare UPIN
CADC25963Medicare ID - Type Unspecified