Provider Demographics
NPI:1053747543
Name:JANG, YOUNGCHUL
Entity type:Individual
Prefix:
First Name:YOUNGCHUL
Middle Name:
Last Name:JANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13890 BRADDOCK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2435
Mailing Address - Country:US
Mailing Address - Phone:703-830-4422
Mailing Address - Fax:703-830-4421
Practice Address - Street 1:13890 BRADDOCK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2435
Practice Address - Country:US
Practice Address - Phone:703-830-4422
Practice Address - Fax:703-830-4421
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557093111N00000X
MDS03678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor