Provider Demographics
NPI:1053614172
Name:NGUYEN, PHUONG T (CHIROPRACTOR)
Entity type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6260 SPRING MOUNTAIN RD STE 105
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-8867
Mailing Address - Country:US
Mailing Address - Phone:702-896-6279
Mailing Address - Fax:702-220-6853
Practice Address - Street 1:6260 SPRING MOUNTAIN RD STE 105
Practice Address - Street 2:SUITE 105
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-8867
Practice Address - Country:US
Practice Address - Phone:702-896-6279
Practice Address - Fax:702-220-6853
Is Sole Proprietor?:No
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00772111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor