Healthcare Provider Details

I. General information

NPI: 1598826943
Provider Name (Legal Business Name): TZUCHIANG FAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 ARMOUR DR
SANTA CLARA CA
95054-1602
US

IV. Provider business mailing address

4645 ARMOUR DR
SANTA CLARA CA
49441-3586
US

V. Phone/Fax

Practice location:
  • Phone: 408-772-4963
  • Fax:
Mailing address:
  • Phone: 408-772-4963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number32815
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number2301009276
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: