Provider Demographics
NPI:1790769248
Name:CHANG, TRU (DC)
Entity Type:Individual
Prefix:
First Name:TRU
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 1:700 W OLIVE AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2435
Mailing Address - Country:US
Mailing Address - Phone:209-722-9089
Mailing Address - Fax:209-722-3656
Practice Address - Street 1:725 W 18TH ST
Practice Address - Street 2:2
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-4602
Practice Address - Country:US
Practice Address - Phone:209-722-9089
Practice Address - Fax:209-722-3656
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27398111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASAT 6226OtherBOARD OF CHIRO EXAMINERS
CADC0273981Medicare ID - Type Unspecified
CASAT 6226OtherBOARD OF CHIRO EXAMINERS