Provider Demographics
NPI:1467051607
Name:TRUONG LLC
Entity Type:Organization
Organization Name:TRUONG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THO
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-267-2723
Mailing Address - Street 1:15292 SE LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-7338
Mailing Address - Country:US
Mailing Address - Phone:503-267-2723
Mailing Address - Fax:503-974-2814
Practice Address - Street 1:8035 SE HOLGATE BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-3369
Practice Address - Country:US
Practice Address - Phone:503-267-2723
Practice Address - Fax:503-974-2814
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:154601190
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500760858Medicaid