Provider Demographics
NPI:1336396134
Name:DR. TIA CHANG & ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:DR. TIA CHANG & ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:TIA
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-771-2250
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:55130-4276
Mailing Address - Country:US
Mailing Address - Phone:651-771-2250
Mailing Address - Fax:651-771-7382
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:55130-4276
Practice Address - Country:US
Practice Address - Phone:651-771-2250
Practice Address - Fax:651-771-7382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty