Provider Demographics
NPI:1407985419
Name:PHAM, MINH TRANG THI (DC)
Entity Type:Individual
Prefix:
First Name:MINH TRANG
Middle Name:THI
Last Name:PHAM
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 1:6715 NICOLLET AVE
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2465
Mailing Address - Country:US
Mailing Address - Phone:612-501-0966
Mailing Address - Fax:612-869-2106
Practice Address - Street 1:6715 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2465
Practice Address - Country:US
Practice Address - Phone:612-501-0966
Practice Address - Fax:612-869-2106
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4195111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor