Provider Demographics
NPI:1881651149
Name:TIEU, PHUONG QUOC (DC)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:QUOC
Last Name:TIEU
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 1:5343 N MACARTHUR BLVD
Mailing Address - Street 2:1137
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9751 WALNUT ST
Practice Address - Street 2:108
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-2397
Practice Address - Country:US
Practice Address - Phone:972-238-0500
Practice Address - Fax:972-238-0045
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9779111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D1369Medicare ID - Type Unspecified