Provider Demographics
NPI:1891713897
Name:NGUYEN, LOC TAN (DC)
Entity Type:Individual
Prefix:DR
First Name:LOC
Middle Name:TAN
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:P.O. BOX 11104
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92685-1104
Mailing Address - Country:US
Mailing Address - Phone:714-530-7500
Mailing Address - Fax:714-530-7555
Practice Address - Street 1:10292 WESTMINSTER AVE.
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4830
Practice Address - Country:US
Practice Address - Phone:714-530-7500
Practice Address - Fax:714-530-7555
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor