Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 25575 | CA |
NPI | 1376782169 |
---|---|
Provider Name | Dr. Brandon G Jung |
First Address | Pinole, CA 94564-1468 |
Second Address | Pinole, CA 94564-1468 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2009 |
Last Update Date | 18/02/2009 |