Provider Demographics
NPI:1679028724
Name:CHANG, SAM (DC)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:
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 1:464 HUDSON TER STE 204
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2917
Mailing Address - Country:US
Mailing Address - Phone:201-567-0005
Mailing Address - Fax:201-567-0051
Practice Address - Street 1:464 HUDSON TER STE 204
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632
Practice Address - Country:US
Practice Address - Phone:201-567-0005
Practice Address - Fax:201-567-0051
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012850111N00000X
NJ38MC00736500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor