Provider Demographics
NPI:1841272713
Name:SHANG, KONG (DC)
Entity type:Individual
Prefix:DR
First Name:KONG
Middle Name:
Last Name:SHANG
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 1:1075 N HILLS BLVD
Mailing Address - Street 2:370
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-5732
Mailing Address - Country:US
Mailing Address - Phone:775-972-4488
Mailing Address - Fax:775-972-1853
Practice Address - Street 1:1075 N HILLS BLVD
Practice Address - Street 2:370
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-5732
Practice Address - Country:US
Practice Address - Phone:775-972-4488
Practice Address - Fax:775-972-1853
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor