Provider Demographics
NPI:1821038639
Name:CHANG CHIROPRACTIC INC
Entity Type:Organization
Organization Name:CHANG CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-337-1377
Mailing Address - Street 1:1803 NE JENSEN BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-7233
Mailing Address - Country:US
Mailing Address - Phone:772-334-1377
Mailing Address - Fax:
Practice Address - Street 1:1803 NE JENSEN BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-7233
Practice Address - Country:US
Practice Address - Phone:772-334-1377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8405261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL64015OtherBLUE CROSS BLUE SHIELD FL
FLK9913Medicare PIN