Provider Demographics
NPI:1346640240
Name:LUONG, TAN (DC)
Entity Type:Individual
Prefix:
First Name:TAN
Middle Name:
Last Name:LUONG
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 1:2010 N PLANO RD
Mailing Address - Street 2:STE 101
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2010 N PLANO RD
Practice Address - Street 2:STE 101
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4429
Practice Address - Country:US
Practice Address - Phone:972-664-1294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11482111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor