Provider Demographics
NPI:1598798993
Name:PHAN CHIROPRACTIC & WELLNESS CTR, INC
Entity Type:Organization
Organization Name:PHAN CHIROPRACTIC & WELLNESS CTR, INC
Other - Org Name:VICTORIA DUONG CHIROPRACTIC INCORPORATED
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:VU
Authorized Official - Middle Name:H
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-590-1892
Mailing Address - Street 1:13037 EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1333
Mailing Address - Country:US
Mailing Address - Phone:714-590-1892
Mailing Address - Fax:
Practice Address - Street 1:13037 EUCLID ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1333
Practice Address - Country:US
Practice Address - Phone:714-590-1892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACOR2496111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty