Provider Demographics
NPI:1952465510
Name:PHAM, THANH DUC (DC)
Entity Type:Individual
Prefix:DR
First Name:THANH
Middle Name:DUC
Last Name:PHAM
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 1:4431 W WALNUT ST STE C
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-4108
Mailing Address - Country:US
Mailing Address - Phone:972-494-5155
Mailing Address - Fax:972-494-5159
Practice Address - Street 1:4431 W WALNUT ST STE C
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-4108
Practice Address - Country:US
Practice Address - Phone:972-494-5155
Practice Address - Fax:972-494-5159
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9712111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor