Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH00034522 | WA |
NPI | 1003940131 |
---|---|
Provider Name | Dr. Chan Ho Park |
First Address | Lakewood, WA 98499-4587 |
Second Address | Lakewood, WA 98499-4587 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 08/07/2007 |