Provider Demographics
NPI:1619935632
Name:CHANG, EDGAR JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:JASON
Last Name:CHANG
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 1:190 E STACY RD STE 306-382
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-8734
Mailing Address - Country:US
Mailing Address - Phone:310-381-0024
Mailing Address - Fax:
Practice Address - Street 1:6888 LINCOLN AVE STE J2
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4107
Practice Address - Country:US
Practice Address - Phone:714-828-2865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC943111N00000X
TX142065111N00000X
CADC28462111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC28462OtherCOMMERCIAL INSURERS
CADC0284620OtherBLUE SHIELD OF CA
CADC28462OtherCOMMERCIAL INSURERS
CAU95621Medicare UPIN