NPIMap

Individual provider Active NPI

Wookeun Jeong, DC

  • Chiropractor
  • Ellicott City, MD
National Provider Identifier
1851401087
Registry record updated Jul 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
S03677 Issued in MD
Practice address
3459 Saint Johns LN Ste 2
Ellicott City, MD 21042-4025
Phone
(410) 461-5695
Fax
(410) 461-5496
NPI assigned
Aug 30, 2006
Last updated
Jul 3, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3455 NC
Chiropractor 111N00000X S03677 MD Primary
Chiropractor 111N00000X 0104556916 VA

Addresses

Primary practice location

3459 Saint Johns LN Ste 2
Ellicott City, MD 21042-4025

Mailing address

3459 Saint Johns LN Ste 2
Ellicott City, MD 21042-4025
Phone (410) 461-5695

Other identifiers 1

IdentifierTypeStateIssuer
08703OtherBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
S03677MDMDChiropractor
0104556916VAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Jeong Chiropractic Center,PLLC Chiropractor PastSince Apr 30, 2007 Accepting new patients
Jeong Wellness Chiropractic, Inc. Chiropractor Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341273600000",
    "number": "1851401087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3459 SAINT JOHNS LN STE 2",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210424025",
            "telephone_number": "410-461-5695",
            "fax_number": "410-461-5496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3459 SAINT JOHNS LN STE 2",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210424025",
            "telephone_number": "410-461-5695",
            "fax_number": "410-461-5496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEONG",
        "first_name": "WOOKEUN",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2012-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "3455",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MD",
            "license": "S03677",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104556916",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "08703",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellicott City, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.