Healthcare Provider Details

I. General information

NPI: 1306776372
Provider Name (Legal Business Name): CHEN AND CHANG CHIROPRACTIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10399 FOOTHILL BLVD STE 104
RANCHO CUCAMONGA CA
91730-6957
US

IV. Provider business mailing address

10399 FOOTHILL BLVD STE 104
RANCHO CUCAMONGA CA
91730-6957
US

V. Phone/Fax

Practice location:
  • Phone: 909-466-8800
  • Fax: 909-466-0088
Mailing address:
  • Phone: 909-466-8800
  • Fax: 909-466-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: GIDEON CHEN
Title or Position: TREASURY
Credential: DC
Phone: 909-466-8800