Provider Demographics
NPI:1992009567
Name:SILOAM CHIROPRACTIC & ACUPUNCTURE, PLLC
Entity Type:Organization
Organization Name:SILOAM CHIROPRACTIC & ACUPUNCTURE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HA
Authorized Official - Middle Name:CHANG
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-820-0993
Mailing Address - Street 1:3043 OLD DENTON RD
Mailing Address - Street 2:STE 106
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5036
Mailing Address - Country:US
Mailing Address - Phone:972-820-0993
Mailing Address - Fax:972-820-0995
Practice Address - Street 1:3043 OLD DENTON RD
Practice Address - Street 2:STE 106
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5036
Practice Address - Country:US
Practice Address - Phone:972-820-0993
Practice Address - Fax:972-820-0995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9211111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1366613176OtherINDIVIDUAL NPI