Provider Demographics
NPI:1285877084
Name:TRAN, CUONG VAN (DC)
Entity type:Individual
Prefix:
First Name:CUONG
Middle Name:VAN
Last Name:TRAN
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 1:4294 MEMORIAL DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1226
Mailing Address - Country:US
Mailing Address - Phone:404-296-4888
Mailing Address - Fax:404-296-8811
Practice Address - Street 1:4294 MEMORIAL DR
Practice Address - Street 2:SUITE D
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1226
Practice Address - Country:US
Practice Address - Phone:404-296-4888
Practice Address - Fax:404-296-8811
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor