Provider Demographics
NPI:1104025824
Name:TIEU, PHUONG THANH (DC)
Entity Type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:THANH
Last Name:TIEU
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 1:508 HIDEAWAY CT
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-3878
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2540 E ARKANSAS LN
Practice Address - Street 2:SUITE 100
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-1768
Practice Address - Country:US
Practice Address - Phone:817-795-2273
Practice Address - Fax:817-795-2274
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC9214111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health