Provider Demographics
NPI:1598067340
Name:TRUONG, JAN VAN (DC)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:VAN
Last Name:TRUONG
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 1:1547 PELICAN BAYOU DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-8082
Mailing Address - Country:US
Mailing Address - Phone:228-238-9158
Mailing Address - Fax:
Practice Address - Street 1:1720A MEDICAL PARK DR
Practice Address - Street 2:160B
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2129
Practice Address - Country:US
Practice Address - Phone:228-206-5389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1711111NR0400X
MS1171111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation