Provider Demographics
NPI:1821189283
Name:TONG, PHUONG L (DC)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:L
Last Name:TONG
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 1:1456 BELT LINE RD
Mailing Address - Street 2:STE 111
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-6802
Mailing Address - Country:US
Mailing Address - Phone:972-414-4878
Mailing Address - Fax:972-675-3202
Practice Address - Street 1:1456 BELT LINE RD
Practice Address - Street 2:STE 111
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-6802
Practice Address - Country:US
Practice Address - Phone:972-414-4878
Practice Address - Fax:972-675-3202
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8870111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R7041OtherBLUE CROSS BLUE SHIELD
TX8R7041OtherBLUE CROSS BLUE SHIELD
TX8D1818Medicare ID - Type Unspecified