Provider Demographics
NPI:1023386828
Name:ELIZABETH NGUYEN, DC., LLC
Entity Type:Organization
Organization Name:ELIZABETH NGUYEN, DC., LLC
Other - Org Name:BACK 2 HEALTH CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:BAO NGOC
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-232-2933
Mailing Address - Street 1:12766 SE STARK ST
Mailing Address - Street 2:PLAZA 125 C
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-1539
Mailing Address - Country:US
Mailing Address - Phone:503-232-2933
Mailing Address - Fax:503-235-9736
Practice Address - Street 1:12766 SE STARK ST
Practice Address - Street 2:PLAZA 125 C
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1539
Practice Address - Country:US
Practice Address - Phone:503-232-2933
Practice Address - Fax:503-235-9736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center