Provider Demographics
NPI:1568561538
Name:TRAN, KHOA VAN (DC)
Entity Type:Individual
Prefix:DR
First Name:KHOA
Middle Name:VAN
Last Name:TRAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:VAN
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:5309 WALZEM RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-2124
Mailing Address - Country:US
Mailing Address - Phone:210-655-4383
Mailing Address - Fax:210-655-3015
Practice Address - Street 1:5309 WALZEM RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-2124
Practice Address - Country:US
Practice Address - Phone:210-655-4383
Practice Address - Fax:210-655-3015
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9215111N00000X
CADC 27550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J3395OtherBC/BS
TX0085151OtherHMO BLUE PROVIDER NO.
TX610549Medicare ID - Type UnspecifiedPROVIDER NO.