Provider Demographics
NPI:1225356884
Name:NGUYEN, THAO (DC)
Entity Type:Individual
Prefix:DR
First Name:THAO
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 N 19TH AVE STE E
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2903
Mailing Address - Country:US
Mailing Address - Phone:602-339-4228
Mailing Address - Fax:602-916-0286
Practice Address - Street 1:5225 N 19TH AVE STE E
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2903
Practice Address - Country:US
Practice Address - Phone:602-339-4228
Practice Address - Fax:602-916-0286
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor