Provider Demographics
NPI:1962514489
Name:CHUNG, GUN (DC)
Entity type:Individual
Prefix:DR
First Name:GUN
Middle Name:
Last Name:CHUNG
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:PO BOX 20172
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042
Mailing Address - Country:US
Mailing Address - Phone:931-221-0200
Mailing Address - Fax:931-552-9400
Practice Address - Street 1:2130 FORT CAMPBELL BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042
Practice Address - Country:US
Practice Address - Phone:931-221-0200
Practice Address - Fax:931-552-9400
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1939111N00000X
GA7370111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5067328OtherCIGNA
TN4126537OtherBCBS
TN4126537OtherBCBS