Provider Demographics
NPI:1972909240
Name:TRUONG, THO
Entity Type:Individual
Prefix:DR
First Name:THO
Middle Name:
Last Name:TRUONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8035 SE HOLGATE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-3369
Mailing Address - Country:US
Mailing Address - Phone:503-267-2723
Mailing Address - Fax:425-814-7395
Practice Address - Street 1:8035 SE HOLGATE BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-3369
Practice Address - Country:US
Practice Address - Phone:503-267-2723
Practice Address - Fax:503-974-2814
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60511050111N00000X
OR5964111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5964Medicaid
WACH60511050OtherCHIROPRACTIC LICENSE