Provider Demographics
NPI:1598979197
Name:NGUYEN, ANTHONY LOC BAO (DC)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:LOC BAO
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 1:10161 BOLSA AVE. STE 206C
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683
Mailing Address - Country:US
Mailing Address - Phone:714-892-0814
Mailing Address - Fax:714-829-3010
Practice Address - Street 1:10161 BOLSA AVE. STE 206C
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683
Practice Address - Country:US
Practice Address - Phone:714-892-0814
Practice Address - Fax:714-829-3010
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2024-07-17
Deactivation Date:2007-06-05
Deactivation Code:
Reactivation Date:2009-03-18
Provider Licenses
StateLicense IDTaxonomies
CA20721111N00000X
CADC20721111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor