Provider Demographics
NPI:1659475127
Name:NGUYEN, HUY QUANG (DC)
Entity Type:Individual
Prefix:DR
First Name:HUY
Middle Name:QUANG
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 1:1426 S COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-4638
Mailing Address - Country:US
Mailing Address - Phone:920-725-0800
Mailing Address - Fax:920-725-6308
Practice Address - Street 1:1801 N RICHMOND ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-2730
Practice Address - Country:US
Practice Address - Phone:920-831-4110
Practice Address - Fax:920-831-4111
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3760-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3760-012OtherWI STATE LICENSE NUMBER
WI38994400Medicaid
WI3760-012OtherWI STATE LICENSE NUMBER