Provider Demographics
NPI:1952401556
Name:OMEGA, ARMANDO TAN (DC)
Entity Type:Individual
Prefix:
First Name:ARMANDO
Middle Name:TAN
Last Name:OMEGA
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 1:1040 W CAPITOL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-2701
Mailing Address - Country:US
Mailing Address - Phone:916-372-8657
Mailing Address - Fax:916-372-9637
Practice Address - Street 1:1040 W CAPITOL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-2701
Practice Address - Country:US
Practice Address - Phone:916-372-8657
Practice Address - Fax:916-372-9637
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC2591300Medicare UPIN