=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972791564
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHANG CHIROPRACTIC CLINIC CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2007
-----------------------------------------------------
Last Update Date | 11/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3661 TORRANCE BLVD STE 201
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-381-0024
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 190 E STACY RD STE 306-382
-----------------------------------------------------
City | ALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75002-8734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-381-0024
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. EDGAR J. CHANG
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 310-381-0024
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC28462
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------