Provider Demographics
NPI:1962508697
Name:FANG, LINDA CARL (DC)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:CARL
Last Name:FANG
Suffix:
Gender:F
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:PO BOX 832
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507
Mailing Address - Country:US
Mailing Address - Phone:928-926-9827
Mailing Address - Fax:925-945-7375
Practice Address - Street 1:2021 YGNACIO VALLEY RD
Practice Address - Street 2:C204
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598
Practice Address - Country:US
Practice Address - Phone:925-926-9827
Practice Address - Fax:925-945-7375
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0254350111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0254350Medicare ID - Type Unspecified
DC0254350Medicare UPIN