Provider Demographics
NPI:1962573741
Name:CHUNG, MICHAEL MC (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MC
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 1:4025 W CHANDLER BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3771
Mailing Address - Country:US
Mailing Address - Phone:480-855-8880
Mailing Address - Fax:480-323-2274
Practice Address - Street 1:4025 W CHANDLER BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3771
Practice Address - Country:US
Practice Address - Phone:480-855-8880
Practice Address - Fax:480-323-2274
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7088111N00000X
AZ01-608D175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ65190Medicare PIN
AZU78758Medicare UPIN