Provider Demographics
NPI:1073742292
Name:NGUYEN, VIET QUANG (DC)
Entity Type:Individual
Prefix:
First Name:VIET
Middle Name:QUANG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5580 PARK BLVD
Mailing Address - Street 2:STE. 2
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-3328
Mailing Address - Country:US
Mailing Address - Phone:727-290-9820
Mailing Address - Fax:727-498-6593
Practice Address - Street 1:5580 PARK BLVD
Practice Address - Street 2:STE. 2
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3328
Practice Address - Country:US
Practice Address - Phone:727-290-9820
Practice Address - Fax:727-498-6593
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9863111N00000X
GACHIRO008441111N00000X
FLACUPUNCTURE CERT.171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACHIRO008441OtherCHIROPRACTIC LICENSE