Provider Demographics
NPI:1164696068
Name:MAI NGUYEN
Entity Type:Organization
Organization Name:MAI NGUYEN
Other - Org Name:377 CHASE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-281-1700
Mailing Address - Street 1:6600 DENTON HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-2541
Mailing Address - Country:US
Mailing Address - Phone:817-281-1700
Mailing Address - Fax:817-281-1773
Practice Address - Street 1:6600 DENTON HWY
Practice Address - Street 2:SUITE 130
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-2541
Practice Address - Country:US
Practice Address - Phone:817-281-1700
Practice Address - Fax:817-281-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9324111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty