Provider Demographics
NPI:1760534812
Name:CHAN, JOSEPH T (PT, L AC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:T
Last Name:CHAN
Suffix:
Gender:M
Credentials:PT, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13186
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-0186
Mailing Address - Country:US
Mailing Address - Phone:310-364-3988
Mailing Address - Fax:310-316-9388
Practice Address - Street 1:21203 HAWTHORNE BLVD STE B
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5520
Practice Address - Country:US
Practice Address - Phone:310-316-2368
Practice Address - Fax:310-316-9388
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC1464171100000X
CAPT9808225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT9808AMedicare UPIN