Provider Demographics
NPI:1205595550
Name:NGUYEN SPINE AND SPORT CHIROPRACTIC
Entity type:Organization
Organization Name:NGUYEN SPINE AND SPORT CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:415-623-9258
Mailing Address - Street 1:2504 SANTA CLARA AVE STE 1-2
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-3074
Mailing Address - Country:US
Mailing Address - Phone:415-623-9258
Mailing Address - Fax:
Practice Address - Street 1:2504 SANTA CLARA AVE STE 1-2
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-3074
Practice Address - Country:US
Practice Address - Phone:415-623-9258
Practice Address - Fax:510-426-8256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-14
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty