Provider Demographics
NPI:1114097797
Name:CHEN, CHIA-CHENG (DC)
Entity Type:Individual
Prefix:DR
First Name:CHIA-CHENG
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:BRIAN
Other - Middle Name:CHIA-CHENG
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:19141 E. COLIMA RD, STE B
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-3072
Mailing Address - Country:US
Mailing Address - Phone:626-964-1598
Mailing Address - Fax:626-964-0148
Practice Address - Street 1:19141 E. COLIMA RD, STE B
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-3072
Practice Address - Country:US
Practice Address - Phone:626-964-1598
Practice Address - Fax:626-964-0148
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23766111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23766AMedicare ID - Type Unspecified
CAU79973Medicare UPIN