Provider Demographics
NPI:1073821377
Name:LAI NGUYEN CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:LAI NGUYEN CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAI
Authorized Official - Middle Name:DUC
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-226-8877
Mailing Address - Street 1:485 LEWIS RD STE C
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-2196
Mailing Address - Country:US
Mailing Address - Phone:408-226-8877
Mailing Address - Fax:408-226-8845
Practice Address - Street 1:485 LEWIS RD STE C
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-2196
Practice Address - Country:US
Practice Address - Phone:408-226-8877
Practice Address - Fax:408-226-8845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC026454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0264540Medicare Oscar/Certification