Provider Demographics
NPI:1295004208
Name:PHAM, BINH CONG (DC)
Entity Type:Individual
Prefix:DR
First Name:BINH
Middle Name:CONG
Last Name:PHAM
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 1:2302 S HWY 121
Mailing Address - Street 2:STE 100
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-8117
Mailing Address - Country:US
Mailing Address - Phone:214-494-9972
Mailing Address - Fax:
Practice Address - Street 1:2628 LONG PRAIRE
Practice Address - Street 2:STE 105
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022
Practice Address - Country:US
Practice Address - Phone:972-899-8002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9240111NN1001X
OK3749111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition