Provider Demographics
NPI:1841680956
Name:KWAN, KARLTON JIANG TEIM (DC)
Entity type:Individual
Prefix:DR
First Name:KARLTON
Middle Name:JIANG TEIM
Last Name:KWAN
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 1:9836 US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-7273
Mailing Address - Country:US
Mailing Address - Phone:352-787-8531
Mailing Address - Fax:352-787-3041
Practice Address - Street 1:9836 US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-7273
Practice Address - Country:US
Practice Address - Phone:352-787-8531
Practice Address - Fax:352-787-3041
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 11408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01-0628458Medicare UPIN