Provider Demographics
NPI:1154470821
Name:CHANG, SHIH-CHIO (LIC AC)
Entity Type:Individual
Prefix:
First Name:SHIH-CHIO
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3913
Mailing Address - Country:US
Mailing Address - Phone:978-201-6424
Mailing Address - Fax:
Practice Address - Street 1:48 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3913
Practice Address - Country:US
Practice Address - Phone:978-201-6424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224313171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist