Provider Demographics
NPI:1184483737
Name:NANTHAVONG, IAN JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:JOSEPH
Last Name:NANTHAVONG
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 1:2011 RICHARD JONES RD APT M4
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2822
Mailing Address - Country:US
Mailing Address - Phone:618-593-2533
Mailing Address - Fax:
Practice Address - Street 1:2011 RICHARD JONES RD APT M4
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2822
Practice Address - Country:US
Practice Address - Phone:618-593-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3802111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor