Provider Demographics
NPI:1255601258
Name:PHAM, ANTHONY QUANG (DC)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:QUANG
Last Name:PHAM
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 1:7817 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-2339
Mailing Address - Country:US
Mailing Address - Phone:503-975-5298
Mailing Address - Fax:503-546-7496
Practice Address - Street 1:7817 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-2339
Practice Address - Country:US
Practice Address - Phone:503-975-5298
Practice Address - Fax:503-546-7496
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5021111N00000X
IL038012525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor