Provider Demographics
NPI:1790899565
Name:TRAN, NICOLE PHUONG (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:PHUONG
Last Name:TRAN
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 1:2304 W. BARDIN RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052
Mailing Address - Country:US
Mailing Address - Phone:972-522-1511
Mailing Address - Fax:972-522-1510
Practice Address - Street 1:2304 W. BARDIN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052
Practice Address - Country:US
Practice Address - Phone:972-522-1511
Practice Address - Fax:972-522-1510
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8484111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor