Provider Demographics
NPI:1295113223
Name:PHAN, TONY (DC)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:PHAN
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 1:11463 GULLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6821
Mailing Address - Country:US
Mailing Address - Phone:832-475-7960
Mailing Address - Fax:
Practice Address - Street 1:431 NURSERY RD STE A600
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-1987
Practice Address - Country:US
Practice Address - Phone:832-605-8993
Practice Address - Fax:844-364-4263
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12932111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor