Provider Demographics
NPI:1316692429
Name:NGUYEN, RICKY (DC)
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:
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 1:10961 WESTMINSTER AVE STE APT
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4929
Mailing Address - Country:US
Mailing Address - Phone:714-636-1744
Mailing Address - Fax:714-844-9249
Practice Address - Street 1:10961 WESTMINSTER AVE STE APT
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4929
Practice Address - Country:US
Practice Address - Phone:714-636-1744
Practice Address - Fax:714-844-9249
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36114111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor