Provider Demographics
NPI:1093252959
Name:VAN, VU-VICTOR CONG (DC)
Entity Type:Individual
Prefix:
First Name:VU-VICTOR
Middle Name:CONG
Last Name:VAN
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 1:475 STATE HIGHWAY 121 BYP STE 100
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-8178
Mailing Address - Country:US
Mailing Address - Phone:870-612-0026
Mailing Address - Fax:
Practice Address - Street 1:475 STATE HIGHWAY 121 BYP STE 100
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-8178
Practice Address - Country:US
Practice Address - Phone:972-315-3576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15755111N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program