Healthcare Provider Details

I. General information

NPI: 1629068481
Provider Name (Legal Business Name): TZERLIN PRONG CHIROPRACTIC PROFESSIONAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 DESIRE AVE. SUITE #205
ROWLAND HEIGHTS CA
91748-2970
US

IV. Provider business mailing address

1722 DESIRE AVE. SUITE #205
ROWLAND HEIGHTS CA
91748-2970
US

V. Phone/Fax

Practice location:
  • Phone: 626-581-3578
  • Fax: 626-581-3450
Mailing address:
  • Phone: 626-581-3578
  • Fax: 626-581-3450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC23459
License Number StateCA

VIII. Authorized Official

Name: TZERLIN PRONG
Title or Position: PRESIDENT
Credential: DC
Phone: 626-581-3578