Provider Demographics
NPI:1780782730
Name:NGUYEN, HOAN-VU QUANG (DC)
Entity type:Individual
Prefix:DR
First Name:HOAN-VU
Middle Name:QUANG
Last Name:NGUYEN
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 1:163 E NORTH WATER ST
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2708
Mailing Address - Country:US
Mailing Address - Phone:920-486-4031
Mailing Address - Fax:920-725-2909
Practice Address - Street 1:163 E NORTH WATER ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2708
Practice Address - Country:US
Practice Address - Phone:920-486-4031
Practice Address - Fax:920-725-2909
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3534111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38907200Medicaid
WI3534OtherSTATE LICENSE NUMBER
WI38907200Medicaid
WI46-2276820OtherTAX ID NUMBER
WIU71216Medicare UPIN