Provider Demographics
NPI:1881122125
Name:NGUYEN, AMY (DC)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 WILLIAMS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4648
Mailing Address - Country:US
Mailing Address - Phone:703-672-1919
Mailing Address - Fax:
Practice Address - Street 1:3060 WILLIAMS DR STE 300
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4648
Practice Address - Country:US
Practice Address - Phone:703-672-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557389111NR0400X
VA0104-557389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0104557389OtherCHIROPRACTIC LICENSE