Provider Demographics
NPI:1194151779
Name:NGUYEN, JIMMY HUYNH (DC)
Entity type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:HUYNH
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 1:14969 HIDDEN OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-7717
Mailing Address - Country:US
Mailing Address - Phone:727-644-1189
Mailing Address - Fax:
Practice Address - Street 1:1550 N FEDERAL HWY
Practice Address - Street 2:SUITE 15
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-2810
Practice Address - Country:US
Practice Address - Phone:561-742-3554
Practice Address - Fax:561-742-3559
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5830111N00000X
FLCH10994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor