Provider Demographics
NPI:1336261973
Name:CHANG, TIMOTHY TIA (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:TIA
Last Name:CHANG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:858 TERRACE CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-4276
Mailing Address - Country:US
Mailing Address - Phone:651-771-2250
Mailing Address - Fax:
Practice Address - Street 1:858 TERRACE CT
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-4276
Practice Address - Country:US
Practice Address - Phone:651-771-2250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor