Provider Demographics
NPI:1225204928
Name:TRUONG, JACK QUOC (DC)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:QUOC
Last Name:TRUONG
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 1:8788 ELK GROVE BLVD
Mailing Address - Street 2:BUILDING 2 SUITE F
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-1766
Mailing Address - Country:US
Mailing Address - Phone:916-687-1291
Mailing Address - Fax:
Practice Address - Street 1:8788 ELK GROVE BLVD
Practice Address - Street 2:BUILDING 2 SUITE F
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-1766
Practice Address - Country:US
Practice Address - Phone:916-687-1291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor