Provider Demographics
NPI:1932631603
Name:CHANG, COLIN (DC)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:
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 1:8322 LAKESHORE TRAIL EAST DR
Mailing Address - Street 2:APT. 913
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-4641
Mailing Address - Country:US
Mailing Address - Phone:904-238-8706
Mailing Address - Fax:
Practice Address - Street 1:8322 LAKESHORE TRAIL EAST DR
Practice Address - Street 2:APT. 913
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-4641
Practice Address - Country:US
Practice Address - Phone:904-238-8706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000002831111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor