Provider Demographics
NPI:1164726030
Name:LIN, CHUNG TAO DYLAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CHUNG TAO
Middle Name:DYLAN
Last Name:LIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 612
Mailing Address - Street 2:
Mailing Address - City:BELLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44813-0612
Mailing Address - Country:US
Mailing Address - Phone:419-866-2109
Mailing Address - Fax:419-886-4787
Practice Address - Street 1:710 CENTERPARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-2848
Practice Address - Country:US
Practice Address - Phone:682-325-4193
Practice Address - Fax:682-325-4194
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11586111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor