Provider Demographics
NPI:1194532754
Name:PAN, MIN Q (DC)
Entity type:Individual
Prefix:
First Name:MIN
Middle Name:Q
Last Name:PAN
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 1:5324 N FAIRVALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-1918
Mailing Address - Country:US
Mailing Address - Phone:626-290-2125
Mailing Address - Fax:
Practice Address - Street 1:5324 N FAIRVALLEY AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-1918
Practice Address - Country:US
Practice Address - Phone:626-290-2125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty