1164726030 NPI number — DR. CHUNG TAO DYLAN LIN D.C.

Table of content: DR. CHUNG TAO DYLAN LIN D.C. (NPI 1164726030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164726030 NPI number — DR. CHUNG TAO DYLAN LIN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIN
Provider First Name:
CHUNG TAO
Provider Middle Name:
DYLAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164726030
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 612
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44813-0612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-866-2109
Provider Business Mailing Address Fax Number:
419-886-4787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 CENTERPARK DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
COLLEYVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76034-2848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
682-325-4193
Provider Business Practice Location Address Fax Number:
682-325-4194
Provider Enumeration Date:
01/06/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  11586 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)