Provider Demographics
NPI:1932124716
Name:PHAM, TRUONG (DC,CERTIFIED ACUP)
Entity Type:Individual
Prefix:DR
First Name:TRUONG
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:DC,CERTIFIED ACUP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 SWIFT AVE.
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3424
Mailing Address - Country:US
Mailing Address - Phone:816-221-7426
Mailing Address - Fax:
Practice Address - Street 1:2014 SWIFT AVE
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3424
Practice Address - Country:US
Practice Address - Phone:816-221-7426
Practice Address - Fax:816-221-7426
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004001514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU99703Medicare UPIN
MO750000Medicare ID - Type Unspecified