Provider Demographics
NPI:1659438109
Name:NGUYEN, HIEN ROGER (DC)
Entity Type:Individual
Prefix:DR
First Name:HIEN
Middle Name:ROGER
Last Name:NGUYEN
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 1:1285 SYMPHONY BLVD
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-9332
Mailing Address - Country:US
Mailing Address - Phone:920-882-6144
Mailing Address - Fax:920-882-6142
Practice Address - Street 1:3225 W SPENCER ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-4306
Practice Address - Country:US
Practice Address - Phone:920-882-6144
Practice Address - Fax:920-882-6142
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38906600Medicaid
WIU70477Medicare UPIN
WIWI1753Medicare PIN