Provider Demographics
NPI:1104339423
Name:PHAM, VU TONY
Entity type:Individual
Prefix:
First Name:VU
Middle Name:TONY
Last Name:PHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 WALNUT PKWY
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5317
Mailing Address - Country:US
Mailing Address - Phone:214-404-4115
Mailing Address - Fax:
Practice Address - Street 1:3112 N JUPITER RD STE 310
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-6564
Practice Address - Country:US
Practice Address - Phone:972-496-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor