Provider Demographics
NPI:1396242582
Name:TRITAN NGUYEN CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:TRITAN NGUYEN CHIROPRACTIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE
Authorized Official - Prefix:DR
Authorized Official - First Name:TAN
Authorized Official - Middle Name:TRI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-832-8221
Mailing Address - Street 1:18805 COX AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-4162
Mailing Address - Country:US
Mailing Address - Phone:408-364-6600
Mailing Address - Fax:408-364-2041
Practice Address - Street 1:18805 COX AVE STE 170
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-4162
Practice Address - Country:US
Practice Address - Phone:408-364-6600
Practice Address - Fax:408-364-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32378111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA126792Medicaid