Provider Demographics
NPI:1891842738
Name:VUONG, JILL ANDREA (DC)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:ANDREA
Last Name:VUONG
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 1:7445 S DURANGO DR STE 105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3611
Mailing Address - Country:US
Mailing Address - Phone:702-453-5000
Mailing Address - Fax:702-453-3007
Practice Address - Street 1:7445 S DURANGO DR STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-3611
Practice Address - Country:US
Practice Address - Phone:702-453-5000
Practice Address - Fax:702-453-3007
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01098111N00000X
CADC-30010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV06110Medicare UPIN