Provider Demographics
NPI:1578518833
Name:NGUYEN, TAI VAN
Entity Type:Individual
Prefix:
First Name:TAI
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-3101
Mailing Address - Country:US
Mailing Address - Phone:972-881-1534
Mailing Address - Fax:
Practice Address - Street 1:7200 INDEPENDENCE PKWY
Practice Address - Street 2:SUITE 204
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-5750
Practice Address - Country:US
Practice Address - Phone:972-312-8650
Practice Address - Fax:972-673-0786
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9878111N00000X
OK3342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor