Provider Demographics
NPI:1962038521
Name:TRUONG, FELISHA (DC)
Entity Type:Individual
Prefix:
First Name:FELISHA
Middle Name:
Last Name:TRUONG
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 1:740 BAIR ISLAND RD APT 202
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-5522
Mailing Address - Country:US
Mailing Address - Phone:206-446-4031
Mailing Address - Fax:
Practice Address - Street 1:1200 BRITTAN AVE
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3931
Practice Address - Country:US
Practice Address - Phone:650-591-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor