Provider Demographics
NPI:1093995813
Name:PHUNG, HENRY Q (DC)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:Q
Last Name:PHUNG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:QUAY
Other - Middle Name:V
Other - Last Name:PHUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7913 CHADWICK LN
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-6716
Mailing Address - Country:US
Mailing Address - Phone:678-469-8641
Mailing Address - Fax:678-479-1317
Practice Address - Street 1:7913 CHADWICK LN
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-6716
Practice Address - Country:US
Practice Address - Phone:678-469-8641
Practice Address - Fax:678-479-1317
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008288111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation