Provider Demographics
NPI:1992849970
Name:CHANG, JAMIE (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:
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 1:1712 BERRYESSA ROAD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133
Mailing Address - Country:UM
Mailing Address - Phone:408-937-8988
Mailing Address - Fax:408-937-8988
Practice Address - Street 1:1712 BERRYESSA RD
Practice Address - Street 2:SUITE 15
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-1067
Practice Address - Country:US
Practice Address - Phone:408-937-8988
Practice Address - Fax:408-937-8222
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor