Provider Demographics
NPI:1346256344
Name:NGUYEN, VAN A (DC)
Entity Type:Individual
Prefix:DR
First Name:VAN
Middle Name:A
Last Name:NGUYEN
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 1:2005 BLOOMINGDALE RD
Mailing Address - Street 2:UNIT C
Mailing Address - City:GLENDALE HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-2151
Mailing Address - Country:US
Mailing Address - Phone:630-893-1260
Mailing Address - Fax:630-893-1261
Practice Address - Street 1:2005 BLOOMINGDALE RD
Practice Address - Street 2:UNIT C
Practice Address - City:GLENDALE HTS
Practice Address - State:IL
Practice Address - Zip Code:60139-2151
Practice Address - Country:US
Practice Address - Phone:630-893-1260
Practice Address - Fax:630-893-1261
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207646Medicare ID - Type Unspecified