Healthcare Provider Details

I. General information

NPI: 1760534812
Provider Name (Legal Business Name): JOSEPH T. CHAN PT, L. AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21203 HAWTHORNE BLVD STE B
TORRANCE CA
90503-5520
US

IV. Provider business mailing address

PO BOX 13186
TORRANCE CA
90503-0186
US

V. Phone/Fax

Practice location:
  • Phone: 310-316-2368
  • Fax: 310-316-9388
Mailing address:
  • Phone: 310-364-3988
  • Fax: 310-316-9388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC1464
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT9808
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: