MEDICARE: DR. TONY TANG DC

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	111NS0005X	Sports Physician Chiropractor	25278	CA

General Provider Information

NPI Number	:	1255571857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TONY TANG DC

Provider Business Mailing Address
First Line	:	13801 ROSWELL AVE
Second Line	:	SUITE G
City	:	CHINO
State	:	CA
Zip	:	91710-5466
Country	:	US
Telephone Number	:	909-548-6868
Fax Number	:	909-548-6855

Provider Business Practice Location Address
First Line	:	13801 ROSWELL AVE
Second Line	:	SUITE G
City	:	CHINO
State	:	CA
Zip	:	91710-5466
Country	:	US
Telephone Number	:	909-548-6868
Fax Number	:	909-548-6855

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

Provider Enumeration Date	:	02/23/2009
Last Update Date	:	02/23/2009

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