Provider Demographics
NPI:1366486177
Name:NGUYEN, CUONG VAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CUONG
Middle Name:VAN
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 1:1108 KEMPER MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-4117
Mailing Address - Country:US
Mailing Address - Phone:513-620-8191
Mailing Address - Fax:
Practice Address - Street 1:1108 KEMPER MEADOW DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-4117
Practice Address - Country:US
Practice Address - Phone:513-620-8194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10716111N00000X
IL038-010443111N00000X
OHDC4233111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK26653Medicare ID - Type Unspecified
ILV08817Medicare UPIN