Provider Demographics
NPI:1407123839
Name:PARK, CHUEL-HONG (DC BCAO)
Entity type:Individual
Prefix:
First Name:CHUEL-HONG
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:DC BCAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:STE # E
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8176
Mailing Address - Country:US
Mailing Address - Phone:770-545-8150
Mailing Address - Fax:770-545-8151
Practice Address - Street 1:2810 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:STE # E
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-8176
Practice Address - Country:US
Practice Address - Phone:770-545-8150
Practice Address - Fax:770-545-8151
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008591111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor