Provider Demographics
NPI:1083708663
Name:CHANG, FRED (DC, LAC)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 E JIMMIE LEEDS RD
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9508
Mailing Address - Country:US
Mailing Address - Phone:609-748-8779
Mailing Address - Fax:609-652-6687
Practice Address - Street 1:106 E JIMMIE LEEDS RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9508
Practice Address - Country:US
Practice Address - Phone:609-748-8779
Practice Address - Fax:609-652-6687
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00600700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU68884Medicare UPIN
NJ121068RXQMedicare PIN
NJ071540Medicare PIN