Provider Demographics
NPI:1942264312
Name:CHANG, KRISTIN DANIELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:DANIELLE
Last Name:CHANG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6070 STATE ROUTE 53
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3395
Mailing Address - Country:US
Mailing Address - Phone:630-434-0122
Mailing Address - Fax:630-963-9344
Practice Address - Street 1:6070 STATE ROUTE 53
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3395
Practice Address - Country:US
Practice Address - Phone:630-434-0122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK26491Medicare PIN