1285861724 NPI number — TUAN DUC NGUYEN CHIROPRACTIC INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285861724 NPI number — TUAN DUC NGUYEN CHIROPRACTIC INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TUAN DUC 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:
Provider Other Organization Name Type Code:
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:
1285861724
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 280
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92811-0280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-554-5304
Provider Business Mailing Address Fax Number:
714-554-6052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10666 CHAPMAN AVE # 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92840-3103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-554-5304
Provider Business Practice Location Address Fax Number:
714-554-6052
Provider Enumeration Date:
06/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
TUAN
Authorized Official Middle Name:
DUC
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-554-5304

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  22941 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DC22941 . This is a "CAL OPTIMA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DC22941 . This is a "ONE CARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DC22941 . This is a "PPO, HMO PRIVATE HEALTH INSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: DC22941 . This is a "MEDICARE DIRECT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DC229410 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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