MEDICARE: DR. ANDRE CHAN HWANG D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	12258	TX

General Provider Information

NPI Number	:	1194076372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDRE CHAN HWANG D.C.

Provider Business Mailing Address
First Line	:	2420 E RANDOL MILL RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-6335
Country	:	US
Telephone Number	:	817-795-7100
Fax Number	:	817-795-7102

Provider Business Practice Location Address
First Line	:	2420 E RANDOL MILL RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-6335
Country	:	US
Telephone Number	:	817-795-7100
Fax Number	:	817-795-7102

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2012
Last Update Date	:	12/16/2014

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