Provider Demographics
NPI:1720678709
Name:CHANG, NICHOLAS EA (DC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:EA
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 1:96-212 WAIAWA RD APT 101
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-3382
Mailing Address - Country:US
Mailing Address - Phone:808-349-2255
Mailing Address - Fax:
Practice Address - Street 1:96-212 WAIAWA RD APT 101
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3382
Practice Address - Country:US
Practice Address - Phone:808-349-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-1477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor