Provider Demographics
NPI:1215380399
Name:TANG-HUSTON, YUNCHIN (DC)
Entity Type:Individual
Prefix:
First Name:YUNCHIN
Middle Name:
Last Name:TANG-HUSTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-7089
Mailing Address - Country:US
Mailing Address - Phone:563-271-9944
Mailing Address - Fax:
Practice Address - Street 1:1523 47TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-7089
Practice Address - Country:US
Practice Address - Phone:563-271-9944
Practice Address - Fax:309-644-4448
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor