Provider Demographics
NPI:1578623633
Name:TUNG, SHOUSAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SHOUSAN
Middle Name:
Last Name:TUNG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:WALTER
Other - Middle Name:SHOUSAN
Other - Last Name:TUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:101 SOUTH SHERMAN STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081
Mailing Address - Country:US
Mailing Address - Phone:972-644-4601
Mailing Address - Fax:972-234-4785
Practice Address - Street 1:101 SOUTH SHERMAN STREET
Practice Address - Street 2:SUITE C
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081
Practice Address - Country:US
Practice Address - Phone:972-644-4601
Practice Address - Fax:972-234-4785
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4534111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601753Medicare ID - Type Unspecified