Provider Demographics
NPI:1740342757
Name:POUNGTHANA, THONGLA (DC)
Entity type:Individual
Prefix:DR
First Name:THONGLA
Middle Name:
Last Name:POUNGTHANA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:LA
Other - Middle Name:
Other - Last Name:POUNGTHANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:105 OLD FIELD CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-2797
Mailing Address - Country:US
Mailing Address - Phone:803-808-9588
Mailing Address - Fax:803-782-9505
Practice Address - Street 1:1945 DECKER BLVD STE 12
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-3425
Practice Address - Country:US
Practice Address - Phone:803-782-9596
Practice Address - Fax:803-782-9505
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor