Provider Demographics
NPI:1700903358
Name:SHENG, TSUNGYAO ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:TSUNGYAO
Middle Name:ROBERT
Last Name:SHENG
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 1:436A 75TH ST
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-4454
Mailing Address - Country:US
Mailing Address - Phone:630-969-7878
Mailing Address - Fax:630-969-6929
Practice Address - Street 1:436A 75TH ST
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-4454
Practice Address - Country:US
Practice Address - Phone:630-969-7878
Practice Address - Fax:630-969-6929
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL022-90077-91OtherBCBS
IL910280Medicare ID - Type Unspecified
ILT87157Medicare UPIN