Provider Demographics
NPI:1093073462
Name:PHAN CHIROPRACTIC
Entity Type:Organization
Organization Name:PHAN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GIA-HUNG
Authorized Official - Middle Name:LONG
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-528-9000
Mailing Address - Street 1:2470 ALVIN AVE
Mailing Address - Street 2:SUITE 30
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1664
Mailing Address - Country:US
Mailing Address - Phone:408-528-9000
Mailing Address - Fax:408-528-9008
Practice Address - Street 1:2470 ALVIN AVE.
Practice Address - Street 2:SUITE 30
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1664
Practice Address - Country:US
Practice Address - Phone:408-528-9000
Practice Address - Fax:408-528-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29087302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization