Provider Demographics
NPI:1437298098
Name:VUONG, TAN M (DC)
Entity Type:Individual
Prefix:
First Name:TAN
Middle Name:M
Last Name:VUONG
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 1:7829 N PERSHING AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-1749
Mailing Address - Country:US
Mailing Address - Phone:209-951-7522
Mailing Address - Fax:209-951-8289
Practice Address - Street 1:7829 N PERSHING AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-1749
Practice Address - Country:US
Practice Address - Phone:209-951-7522
Practice Address - Fax:209-951-8289
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARDC0273010Medicare ID - Type Unspecified