Provider Demographics
NPI:1578786471
Name:PHAN, DIEU (DC)
Entity Type:Individual
Prefix:DR
First Name:DIEU
Middle Name:
Last Name:PHAN
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 1:1385 W ALAMEDA AVENUE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223
Mailing Address - Country:US
Mailing Address - Phone:303-777-0125
Mailing Address - Fax:303-777-0103
Practice Address - Street 1:1385 W ALAMEDA AVE.
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80223-2040
Practice Address - Country:US
Practice Address - Phone:303-777-1025
Practice Address - Fax:303-777-0103
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor