Provider Demographics
NPI:1487284972
Name:CHUNG, BONNIE (DC)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 ADAMS ST APT 210
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1771
Mailing Address - Country:US
Mailing Address - Phone:857-415-9167
Mailing Address - Fax:
Practice Address - Street 1:10 CORDAGE PARK CIR STE 227
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7318
Practice Address - Country:US
Practice Address - Phone:508-830-6991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor