Provider Demographics
NPI:1821140393
Name:TSAI, MARK CHINGCHUAN (DC & LAC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:CHINGCHUAN
Last Name:TSAI
Suffix:
Gender:M
Credentials:DC & LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 EAST H STREET
Mailing Address - Street 2:SUITE 701A
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5304
Mailing Address - Country:US
Mailing Address - Phone:619-422-6130
Mailing Address - Fax:619-422-6170
Practice Address - Street 1:316 EAST H STREET
Practice Address - Street 2:SUITE 701A
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5304
Practice Address - Country:US
Practice Address - Phone:619-422-6130
Practice Address - Fax:619-422-6170
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24643111N00000X
CA8609171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 24643Medicare ID - Type Unspecified