Provider Demographics
NPI:1619138559
Name:PHAM, HONGNHUNG (DC)
Entity Type:Individual
Prefix:
First Name:HONGNHUNG
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8996 W BOWLES AVE STE J
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-3480
Mailing Address - Country:US
Mailing Address - Phone:303-968-9321
Mailing Address - Fax:
Practice Address - Street 1:8996 W BOWLES AVE
Practice Address - Street 2:UNIT J
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-8603
Practice Address - Country:US
Practice Address - Phone:303-948-9988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6080111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO40787Medicare PIN