Provider Demographics
NPI:1972846095
Name:DOAN, PHUONG MINH (DC)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:MINH
Last Name:DOAN
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 1:2414 E AMARILLO BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79107-5639
Mailing Address - Country:US
Mailing Address - Phone:806-418-2562
Mailing Address - Fax:806-418-2564
Practice Address - Street 1:2414 E AMARILLO BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79107-5639
Practice Address - Country:US
Practice Address - Phone:806-418-2562
Practice Address - Fax:806-418-2564
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12307111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor