Healthcare Provider Details

I. General information

NPI: 1255571857
Provider Name (Legal Business Name): TONY TANG DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13801 ROSWELL AVE SUITE G
CHINO CA
91710-5466
US

IV. Provider business mailing address

13801 ROSWELL AVE SUITE G
CHINO CA
91710-5466
US

V. Phone/Fax

Practice location:
  • Phone: 909-548-6868
  • Fax: 909-548-6855
Mailing address:
  • Phone: 909-548-6868
  • Fax: 909-548-6855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number25278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: