Provider Demographics
NPI:1174133490
Name:YJP SPINE CENTER LLC
Entity type:Organization
Organization Name:YJP SPINE CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YUNJAE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-628-0733
Mailing Address - Street 1:4920 W THUNDERBIRD RD STE 112
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4906
Mailing Address - Country:US
Mailing Address - Phone:623-487-3444
Mailing Address - Fax:
Practice Address - Street 1:4920 W THUNDERBIRD RD STE 112
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4906
Practice Address - Country:US
Practice Address - Phone:623-487-3444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-01
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty