Provider Demographics
NPI:1265064844
Name:CHANG, KA BAO (DC)
Entity type:Individual
Prefix:DR
First Name:KA BAO
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 1:6625 PAWNEE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-2849
Mailing Address - Country:US
Mailing Address - Phone:828-443-0777
Mailing Address - Fax:
Practice Address - Street 1:6625 PAWNEE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-2849
Practice Address - Country:US
Practice Address - Phone:828-443-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5094111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty