Provider Demographics
NPI:1053760272
Name:NGUYEN CHIROPRACTIC WELLNESS CENTER, P.C.
Entity type:Organization
Organization Name:NGUYEN CHIROPRACTIC WELLNESS CENTER, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAUNCE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHOENYX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-998-5463
Mailing Address - Street 1:2114 SENTER RD
Mailing Address - Street 2:SUITE 23
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-2608
Mailing Address - Country:US
Mailing Address - Phone:408-998-5463
Mailing Address - Fax:408-998-5464
Practice Address - Street 1:2114 SENTER RD
Practice Address - Street 2:SUITE 23
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-2608
Practice Address - Country:US
Practice Address - Phone:408-998-5463
Practice Address - Fax:408-998-5464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29774302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization