1164430914 NPI number — NGUYEN CHIROPRACTIC, INC.

Table of content: (NPI 1164430914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164430914 NPI number — NGUYEN CHIROPRACTIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NGUYEN CHIROPRACTIC, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VERMILION CHIROPRACTIC CLINIC
Provider Other Organization Name Type Code:
3
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:
1164430914
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1720 VETERANS MEMORIAL DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABBEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-898-2225
Provider Business Mailing Address Fax Number:
337-893-0253

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1720 VETERANS MEMORIAL DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABBEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-898-2225
Provider Business Practice Location Address Fax Number:
337-893-0253
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
TUAN-ANH NGUYEN
Authorized Official Middle Name:
DEREK
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
337-898-2225

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1996491 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3307F . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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