Provider Demographics
NPI:1487890802
Name:FUNCTIONAL CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:FUNCTIONAL CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIN
Authorized Official - Middle Name:WOO
Authorized Official - Last Name:SUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-688-6999
Mailing Address - Street 1:126 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-6109
Mailing Address - Country:US
Mailing Address - Phone:978-688-6999
Mailing Address - Fax:
Practice Address - Street 1:126 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-6109
Practice Address - Country:US
Practice Address - Phone:781-244-7301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2862111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty