Provider Demographics
NPI:1275568917
Name:TANG, EDWARD (DC, MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:TANG
Suffix:
Gender:M
Credentials:DC, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2628 LONG PRAIRIE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4839
Mailing Address - Country:US
Mailing Address - Phone:972-395-5755
Mailing Address - Fax:972-899-8003
Practice Address - Street 1:2628 LONG PRAIRIE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4839
Practice Address - Country:US
Practice Address - Phone:972-395-5755
Practice Address - Fax:972-899-8003
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC8651111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U95342Medicare UPIN
TX609829Medicare ID - Type Unspecified