Provider Demographics
NPI: | 1366794786 |
---|---|
Name: | JK HEALTH CARE GROUP, INC |
Entity type: | Organization |
Organization Name: | JK HEALTH CARE GROUP, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JUNG |
Authorized Official - Middle Name: | B |
Authorized Official - Last Name: | KIM |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 770-817-9608 |
Mailing Address - Street 1: | 3775 VENTURE DR |
Mailing Address - Street 2: | BLD #N |
Mailing Address - City: | DULUTH |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30096-5102 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 770-817-9608 |
Mailing Address - Fax: | 770-817-9610 |
Practice Address - Street 1: | 3775 VENTURE DR |
Practice Address - Street 2: | BLD #N |
Practice Address - City: | DULUTH |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30096-5102 |
Practice Address - Country: | US |
Practice Address - Phone: | 770-817-9608 |
Practice Address - Fax: | 770-817-9610 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-10-09 |
Last Update Date: | 2012-10-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
GA | CHIR007922 | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Multi-Specialty |