Provider Demographics
NPI:1023625241
Name:CHOI, IMMANUYEL S (DC)
Entity type:Individual
Prefix:
First Name:IMMANUYEL
Middle Name:S
Last Name:CHOI
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 1:4930 VERDUGO WAY
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8631
Mailing Address - Country:US
Mailing Address - Phone:805-388-8380
Mailing Address - Fax:
Practice Address - Street 1:4930 VERDUGO WAY
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8631
Practice Address - Country:US
Practice Address - Phone:805-388-8380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34835111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor