Healthcare Provider Details

I. General information

NPI: 1326693938
Provider Name (Legal Business Name): IAN HUANG DC, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14145 ROBERT PARIS CT
CHANTILLY VA
20151-4201
US

IV. Provider business mailing address

14145 ROBERT PARIS CT
CHANTILLY VA
20151-4201
US

V. Phone/Fax

Practice location:
  • Phone: 571-443-1718
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104557554
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: