Provider Demographics
NPI:1366613176
Name:SONG, HACHANG KEVIN (DC)
Entity type:Individual
Prefix:
First Name:HACHANG
Middle Name:KEVIN
Last Name:SONG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 ROYAL LN # 105
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-3219
Mailing Address - Country:US
Mailing Address - Phone:972-247-1522
Mailing Address - Fax:972-247-1532
Practice Address - Street 1:2000 ROYAL LN # 105
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-3219
Practice Address - Country:US
Practice Address - Phone:972-247-1522
Practice Address - Fax:972-247-1532
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9211111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor