Provider Demographics
NPI:1699876250
Name:CHUN, JACON C (DPT)
Entity type:Individual
Prefix:MR
First Name:JACON
Middle Name:C
Last Name:CHUN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:MR
Other - First Name:JACON
Other - Middle Name:CHI-KEEN
Other - Last Name:CHUN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:2520 RIFLEMAN CV
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-3492
Mailing Address - Country:US
Mailing Address - Phone:510-393-7750
Mailing Address - Fax:
Practice Address - Street 1:2520 RIFLEMAN CV
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-3492
Practice Address - Country:US
Practice Address - Phone:510-393-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT242662251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports